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WORKS 

IN  THE  VARIOUS  DEPARTMENTS 

OF 

MEDICINE  AND  SURGERY: 

PUBLISHED 

BY 

LEA  & BLANCHARD. 


ANATOMY. 

ANATOMICAL  ATLAS,  illustrative  of  the  Structure  of  the  Human  Body ; with  over 
Six  Hundred  Illustrations  ; the  most  complete  work  of  the  kind  ever  issued, — beau- 
tifully executed,  in  one  volume  imperial  octavo  ; by  H.  H.  Smith,  M.  D.,  under  the 
supervision  of  Professor  W.  E.  Horner. 

HORNER’S  Special  Anatomy  and  Histology ; 7th  edition,  much  improved.  2 vols. 
8vo. 

HORNER’S  Dissector.  In  one  vol.  12mo.  With  many  cuts,  almost  a new  work. 

WILSON’S  Human  Anatomy;  second  edition,  revised,  with  additions  by  Dr.  God- 
dard : 207  beautiful  cuts.  8vo.  608  pages. 

WILSON’S  Dissector,  or  Practical  and  Surgical  Anatomy  ; with  additions  by  God- 
dard : 106  cuts.  Royal  12mo.  444  pages. 

PHYSIOLOGY. 

CARPENTER’S  Principles  of  Human  Physiology;  with  notes  and  additions  by  Mere- 
dith Clymer,  M.  D.  Second  edition,  with  over  200  illustrations — in  8vo.  650  pages. 

CARPENTER’S  Comparative  Physiology ; with  numerous  plates  and  cuts. — Preparing. 

CARPENTER’S  Elements  or  Manual  of  Physiology  and  Physiological  Anatomy. — 
In  one  octavo  volume,  with  180  illustrations.  570  pages.  A new  work. 

DUNGLISON’S  Human  Physiology;  the  6th  edition,- with  numerous  additions  and  370 
cuts — in  2 large  vols.  8vo. 

HARRISON  on  the  Nervous  System.  8vo.  292  pages. 

MULLER’S  Elements  of  Physiology  ; by  Baly,  arranged  by  Bell.  8vo.  886  pages. 

ROGET’S  Outlines  of  Physiology.  8vo.  516  pages. 

TODD  AND  BOWMAN’S  Physiological  Anatomy  and  Physiology  of  Man.  Publish- 
ing in  the  Medical  News  and  Library,  many  cuts. 

PATHOLOGY. 

ABERCROMBIE  on  the  Brain  ; third  edition.  8vo.  324  pages. 

ABERCROMBIE  on  the  Stomach  ; new  edition.  1 vol.  8vo.  320  pages. 

ALISON’S  Outlines  of  Pathology.  8vo.  424  pages. 

ANDRAL  on  the  Blood  in  Disease.  Translated  by  Meigs  and  Stille.  130  pages,  Svo. 

BERZELIUS  on  the  Kidneys  and  Urine.  8vo.  178  pages. 

BARTLETT  on  the  Fevers  of  the  United  States.  Svo.  394  pages. 

BILLINGS’  Principles  of  Medicine.  8vo.  304  pages. 

BIRD  on  Urinary  Deposits.  1 vol.  8vo.  Cuts.  228  pages. 

BUDD  on  the  Liver.  1 vol.  8vo.  392  pages.  Woodcuts  and  coloured  plates. 

CLYMER  on  Fevers  ; a new  and  complete  work.  1 octavo  volume.  600  pages. 

HASSE’S  Pathological  Anatomy  of  the  Organs  of  Respiration  and  Circulation.  1 vol, 
8vo. 

HOPE’S  Treatise  on  the  Diseases  of  the  Heart  and  Great  Vessels;  with  additions  by 
Pennock.  Svo.  With  plates. 


LEA  & BLANCHARD’S  MEDICAL  PUBLICATIONS. 


PATHOLOGY— Continued. 

HUGHES  on  the  Lungs  and  Heart.  1 vol.  12mo.  270  pages.  With  a plate. 

JONES  (T.  Wharton)  on  the  Diseases  of  the  Eye.  1 vol.  8vo.  With  many  cuts. 
Preparing. 

LAWRENCE’S  Treatise  on  the  Diseases  of  the  Eye;  with  additions  by  Hays,  and 
numerous  cuts.  One  large  octavo  volume. 

PROUT’S  Treatise  on  Stomach  and  Renal  Diseases;  with  colored  plates.  8vo.  466 
pages. 

PHILIP’S  Treatise  on  Protracted  Indigestion.  8vo.  240  pages. 

PHILLIPS  on  Scrofula,  its  Causes,  Symptoms  and  Treatment.  1 vol.  8vo. 

RICORD’S  Treatise  on  Venereal  Diseases.  8vo.  256  pages. 

WALSHE’S  Diagnosis  of  the  Diseases  of  the  Lungs.  12mo.  310  pages. 

WILSON  on  the  Diseases  of  the  Skin.  8vo.  370  pages. 

WILLIAMS’  Principles  and  Pathology;  with  additions  by  Clymer.  8vo.  384  pages. 
WILLIAMS  on  the  Respiratory  Organs;  edited  by  Clymer.  8vo.  500  pages. 

PRACTICE  OF  MEDICINE. 

ASHWELL  on  the  Diseases  of  Females,  by  Goddard.  1 vol.  8vo.  520  pages. 
BENEDICT’S  Compendium  of  Chapman’s  Lectures.  1 neat  8vo.  vol.  260  pages. 
CHAPMAN  on  Thoracic  and  Abdominal  Viscera.  8vo.  384  pages. 

CHAPMAN  on  Eruptive  Fevers,  &c.  8vo.  450  pages. 

CONDIE’S  Practical  Treatise  on  the  Diseases  of  Children.  1 vol.  8vo.  650  pages. 
CHURCHILL  on  the  Diseases  of  Females,  including  those  of  Pregnancy  and  Child- 
bed; with  additions  by  Huston.  Third  Edition.  8vo.  572  pages. 

COATES’  Popular  Medicine.  8vo.  514  pages. 

COLOMBAT  de  L’lsfere  on  Females.  Translated  and  edited  by  Meigs.  1 vol.  large 
8vo.  Cuts.  720  pages. 

DE  WEES  on  the  Diseases  of  Children,  8th  edition.  8vo.  548  pages. 

DEWEES  on  the  Diseases  of  Females.  8vo.  With  plates.  532  pages. 
DUNGLISON’S  Practice  of  Medicine.  Second  Edition,  in  2 volumes  8vo.  1322 
pages. 

WATSON  on  the  Principles  and  Practice  of  Physic.  Second  Edition,  by  Condie. 
8vo.  1060  large  pages. 

SURGERY. 

BRODIE  on  the  Urinary  Organs.  8vo.  214  pages. 

BRODIE  on  the  Diseases  of  the  Joints.  8vo.  216  pages. 

BRODIE’S  Surgical  Lectures.  1 vol.  8vo.  352  pages. 

CHELIUS’S  System  of  Surgery,  by  South  and  Norris.  Publishing  in  numbers,  at  50 
cents. 

COOPER  (Sir  Astley)  on  Hernia;  with  lithographic  plates.  Imp.  8vo.  428  pages. 
COOPER  (Sir  Astley/  on  the  Testis  and  Thymus  Gland.  With  many  plates.  Imp.  Svo. 
COOPER  (Sir  Astley)  on  Dislocations  and  Fractures.  With  133  cuts.  Svo.  500  pages. 
COOPER  on  the  Anatomy  and  Diseases  of  the  Breast,  with  Miscellaneous  Surgical 
Essays.  1 large  imp.  Svo.  vol.  36  plates. 

DRUITT’S  Modern  Surgery.  Second  edition.  With  153  cuts.  8vo.  568  pages. 
FERGUSSON’S  System  of  Practical  Surgery.  Second  edition,  by  Norris.  With  246 
cuts.  Svo.  640  pages. 

GUTHRIE  on  the  Bladder  and  Urethra.  1 vol.  Svo.  150  pages. 

HARRIS  on  the  Maxillary  Sinus.  8vo.  164  pages. 

LAWRENCE’S  Treatise  on  Ruptures.  8vo.  4S0  pages. 

LISTON’S  Lectures  on  Surgical  Operations  ; edited  by  Mutter.  1 vol.  Svo.  566  pages. 
216  cuts. 

MAURY’S  Dental  Surgery;  with  numerous  plates  and  cuts.  8vo.  286  pages. 
MILLER’S  Principles  of  Surgery.  1 vol.  8vo.  526  pages. 

MILLER’S  Practice  of  Surgery.  1 vol.  8vo.  496  pages. 

ROBERTSON  on  the  Teeth.  8vo.  230  pages. 


LEA  & BLANCHARD’S  MEDICAL  PUBLICATIONS. 


THERAPEUTICS  AND  MATERIA  MEDIC  A. 

DUNGLISON’S  Therapeutics  and  Materia  Medica  ; a new  edition.  2 vols.  8vo.  986 
pages.  Numerous  cuts. 

DUNGLISON’S  Treatise  on  New  Remedies.  Fifth  edition.  8vo.  616  pages. 

LLLIS’S  Medical  Formulary,  by  Morton.  Seventh  edition.  8vo.  262  pages. 

’EREIRA’S  Elements  of  Materia  Medica  and  Therapeutics  ; edited  by  Carson. 
With  280  cuts.  Second  edition.  2 vols.  8vo.  1580  pages. 

ROYLE’S  Materia  Medica  and  Therapeutics ; edited  by  Carson.  1 vol.  8vo.  Many 
cuts. 

OBSTETRICS. 

DHURCHILL  on  the  Theory  and  Practice  of  Midwifery,  by  Huston.  228  cuts.  8vo. 
528  pages.  Second  edition. 

DEWEES’  System  of  Midwifery  ; with  plates.  Tenth  edition.  Svo.  660  pages. 

RIGBY’S  System  of  Midwifery ; with  cuts.  Svo.  492  pages. 

RAMSBOTHAM  on  Parturition ; with  lithographic  plates.  Imp.  8vo.  458  pages. 

CHEMISTRY,  MEDICAL  PHYSICS  AND  HYGIENE. 

ARNOTT’S  Elements  of  Physics;  with  numerous  cuts.  1 vol.  8vo.  520  pages. 

BRIGHAM  on  the  Influence  of  Mental  Cultivation  and  Excitement.  1 vol.  12mo. 
204  pages. 

DUNGLISON  on  Human  Health;  second  edition  revised,  with  additions.  8vo.  464 
pages. 

ESQUIROL  on  Insanity.  Translated  by  Hunt.  1 vol.  8vo.  496  pages. 

FOWNE'S  Chemistry  for  Students.  1 vol.  large  12mo.  460  pages.  Many  cuts. 

GRAHAM’S  Elements  of  Chemistry,  by  Bridges.  With  numerous  cuts.  8vo.  750 
pages. 

SIMON’S  Chemistry  of  Man.  Translated  by  Day.  1 vol.  8vo.  With  plates. 

THOMSON  on  the  Sick  Room.  1 vol.  12mo.  360  pages.  Cuts. 

MEDICAL  JURISPRUDENCE  AND  MEDICAL  EDUCATION. 

BARTLETT’S  Philosophy  of  Medicine.  1 vol.  8vo.  Extra  cloth.  312  pages. 

CHITTY’S  Medical  Jurisprudence.  8vo.  510  pages. 

DUNGLISON’S  Medical  Student ; a new  edition.  Large  12mo.  312  pages. 

TAYLOR’S  Medical  Jurisprudence  ; edited  by  Griffith.  1 vol.  8vo.  540  pages. 

TRAILL’S  Medical  Jurisprudence.  8vo.  234  pages. 

DICTIONARIES  AND  JOURNALS. 

AMERICAN  JOURNAL  OF  THE  MEDICAL  SCIENCES;  edited  by  Dr.  Isaac 
Hays,  published  Quarterly  at  Five  Dollars  a Year. 

CYCLOPAEDIA  OF  PRACTICAL  MEDICINE;  comprising  Treatises  on  the  Nature 

; and  Treatment  of  Diseases,  including  those  of  Women  and  Children,  Materia  Medica, 
Therapeutics,  Medical  Jurisprudence,  S,-c.  fyc.  Edited  by  Forbes,  Tweedie,  Conolly 
and  Dunglison.  4 large  super-royal  octavo  volumes.  About  3000  pages  in  double 
columns. 

DUNGLISON’S  MEDICAL  DICTIONARY;  6th  edition,  containing  over  40,000 
words  and  synonymes.  Large  8vo.  of  over  800  pages,  double  columns. 

HOBLYN’S  MEDICAL  DICTIONARY;  edited  by  Hays.  1 vol.  royal  12mo.  402 
pages. 

MEDICAL  NEWS  AND  LIBRARY.  Published  Monthly  atOne  Dollar  a Year. 

SELECT  MEDICAL  ESSAYS;  by  Drs.  Dunglison,  Chapman  and  others.  2 vols. 
8vo.  1150  pages. 


ANEW  MEDICAL  DICTIONARY. 

In  one  volume,  large  12mo.,  now  ready,  at  a low  price. 


A DICTIONARY 

OF 

TEEMS  USED  IN  MEDICINE 

AND 

THE  COLLATERAL  SCIENCES; 

BY 

RICHARD  D.  HOBLYN,  AX,  OXON. 

FIRST  AMERICAN,  FROM  THE  SECOND  LONDON  EDITION 
REVISED,  WITH  NUMEROUS  ADDITIONS, 

BY  ISAAC  HAYS,  M.D., 

EDITOR  OF  THE  AMERICAN  JOURNAL  OF  THE  MEDICAL  SCIENCES. 

OPINIONS  OF  THE  PRESS. 

**We  hardly  remember  to  have  seen  so  much  valuable  matter  condensed  into  such  a small 
compass  as  this  little  volume  presents.  The  first  edition  was  published  in  1635,  and  the  present 
<£iay  be  said  to  be  almost  rewritten,  introducing  the  most  recent  terms  on  each  subject  The 
Etymology,  Greek,  Latin,  &c.t  is  carefully  attended  to,  and  the  explanations  are  clear  and  precise: 

44  We  cannot  too  strongly  recommend  this  small  and  cheap  volume  to  the  library  of  every  stu- 
dent and  every  practitioner.” — Medico- Chirurgical  Review. 


41  We  gave  a very  favourable  account  of  this  little  book  on  its  first  appearance,  and  we  have 
only  to  repeat  the  praise  with  increased  emphasis.  It  is,  for  its  size,  decidedly  the  best  book  of  the 
kind,  and  ought  to  be  in  the  possession  of  every  student.  Its  plan  is  sufficiently  comprehensive, 
and  it  contains  an  immense  mass  of  necessary  information  in  a very  small  compass.’  ’ — British  and 
Foreign  Medical  Review. 


44A  work  much  wanted,  and  very  ably  executed.”—  London  Medical  Journal . 


“This  compendious  volume  is  well  adapted  for  the  use  of  students.  It  contains  a complete 
glossary  of  the  terms  used  in  medicine, — not  only  those  in  common  use,  but  also  the  more  recent 
and  less  familiar  names  introduced  by  modem  writers.  The  introduction  of  tabular  news  of 
different  subjects  is  at  one©  comprehensive  and  satisfactory.” — Medical  Oazeite . 


41  Concis©  and  ingenious.” — Johnson's  Medico- Chirur.  Journal. 


44  It  is  a very  learned,  pains-taking,  complete,  and  useful  work,— a Dictionary  absolutely  neces- 
sary in  a medical  library.”— Spectator. 


This  is  a work  that  we  can  cheerfully  recommend  to  all  medical  students,  and  to  every  physi- 
eian  who  occasionally  stumbles  across  words,  with  the  meaning  of  which  he  is  not  entirely  fa- 
miliar. It  indeed  fully  comes  up  to  what  a dictionary  of  terms  ought  to  be  — full  enough  to 
express  the  entire  signification  of  a word  in  all  its  bearings,  and  yet  concise  enough  to  have 
that  definition  remembeted.  Some  dictionaries,  that  aspire  to  the  character  of  multum  in  parvo, 
are  merely  vocabularies  of  synonyms,  in  which  you  may  seek  in  vain  for  a satisfactory  exnlana- 
tion  of  the  meaning  of  terms  ; while  pthers  are  essays  on  every  subject  embraced  within  the 
wide  domain  of  the  medical  and  physical  sciences.  Mr.  Hoblyn  has  hit  upon  the  happy  medium, 
and  produced  a work  that  must  be  highly  esteemed  by  the  medical  profession.  He  not  only  gives 
a very  accurate  and  full  account  of  the  meaning  of  every  term  employed  in  medicine,  but  also 
its  etymology,  which  is  very  important  in  fixing  the  meaning  in  the  mind.  The  editor  has  per- 
formed no  sham  work  in  bringing  it  out;  but  has  done,  bona  fide,  what  he  has  undertaken,  as  he 
always  does.  Ho  has,  not  only  in  name,  but  in  truth,  44  revised  and  adapted  it  to  the  wants  of 
tns  American  practitioner,”— having  added  our  native  medicinal  plants,  officinal  preparations, 
&c.,  and  made  the  work  conform  to  the  Pharmacopoeia  of  the  United  States.  His  additions  are 
numerous,  and  display  a knowledge  of  medicinal  terms,  highly  creditable  to  his  talents  and  in- 
dustry.”— The  Mew  York  Journal  of  Medicine. 


It  is  concise,  and  so  may  be  made  the  constant  companion  of  the  student.— and.  beiDg  small, 
is  also  cheap.  1 he  fact  that  it  has  passed  under  the  revision  of  Dr.  Hays,  is  a guaranty  that  it 
contains  every  thing  that  might  be  looked  for  in  such  a work.  We  take  it  to  be  specially  adapt- 
ed to  the  wants  of  medical  students  during  ther  attendance  upon  lectures,  to  whom  its  portablo 
form  and  small  cost  will  be  strong  recommendations.  Dr.  Hays,  by  various  additions  ana  altera- 
tions, has  adapted  it  to  the  American  reader."  — The  Western  Journal  of  Medicine  and 
6 urgery. 


UNITED  STATES 


DISSECTOR 


THE 


UNITED  STATES 

DISSECTOR, 

OR 

LESSONS  IN  PRACTICAL  ANATOMY. 

BY 

WM.  E.  HORNER,  M.  D., 

PROFESSOR  OF  ANATOMY  IN  THE  UNIVERSITY  OF  PENNSYLVANIA. 

FOURTH  EDITION,  WITH  NUMEROUS  ILLUSTRATIONS. 

EDITED 

BY 

HENRY  H.  SMITH,  M.  D., 

FELLOAV  OF  THE  COLLEGE  OF  PHYSICIANS,  OF  PHILAD.,  &C. 


PHILADELPHIA: 

LEA  & BLANCHARD. 


1846. 


Entered,  according  to  the  Act  of  Congress,  in  the  year  one  thousand 
eight  hundred  and  forty-six,  by 

WM.  E.  HORNER,  M.  D., 

in  the  Clerk’s  Office  of  the  District  Court,  of  the  Eastern  District  of  Penn- 
sylvania. 


GRIGGS  & CO.,  PRINTERS. 


PREFACE 


TO  THE 

THIRD  EDITION. 


The  following  sheets  were  put  together  originally,  with  a 
hope  of  their  contributing  to  facilitate  the  most  difficult  and 
important  part  of  a medical  education,  the  study  of  Practical 
Anatomy,  or  of  Anatomy  by  personal  dissections ; and  are 
the  result  of  many  observations  made  in  the  course  of  twenty- 
four  years  by  myself,  or  by  the  young  men  who  have  con- 
fided in  me,  by  submitting  to  my  instructions.  The  ar- 
rangement is  in  some  respects  unusual,  as  regards  a work 
on  this  branch  of  science  ; but  has  arisen  from  much  reflec- 
tion on  the  subject,  and  from  a careful  observation  of  that 
course  which  students  are  most  disposed  to  adopt  when  left 
to  themselves.  There  are  but  few  men  possessed  of  mo- 
derate activity  of  mind,  who  do  not,  in  the  prosecution  of 
a study  even  new  to  them,  adopt  some  labour-saving  means, 
overlooked  and  sometimes  unknown,  to  such  as  are  much 
farther  advanced.  It  has  happened  to  me  frequently,  while 
superintending  tire  studies  of  others,  to  observe  this  fact;  and 
also,  that  none  of  the  books  in  common  use  answered  con- 
tinually for  reference,  either  in  consequence  of  their  actual 
plan  not  being  suitable  to  the  course  of  dissections,  or  from 


via 


PREFACE. 


the  partition  of  the  subject  among  several  students,  causing 
the  dissection  of  one  person  to  interfere  with  that  of  another. 
The  idea  of  forming  a text-book  to  obviate  the  latter  was 
thus  suggested;  and  I trust,  therefore,  that  the  present  trea- 
tise will,  in  most  cases,  be  found  to  answer  either  where 
several  students  dissect  together  on  the  same  subject,  or 
where  the  student  dissects  alone  upon  a portion  of  the  body. 

In  the  original  conception  of  the  work,  it  appeared  to  me, 
that  I might  introduce  advantageously  remarks  on  Morbid 
Anatomy,  &c.,  but  in  computing  the  number  of  pages  that 
the  descriptive  anatomy  alone  would  occupy,  I found  that 
such  a mass  of  materials  would  rather  become  a System,  and 
interfere  much  with  the  simplicity  and  conciseness  that  I 
wished  to  predominate  in  the  character  of  the  performance. 
I have  therefore  intentionally  indulged  very  seldom  in  such 
remarks,  but  as  their  introduction  is  common  in  manuals 
of  Anatomy,  I will  state  why  it  has  not  been  imitated  in  the 
present.  In  my  own  progress  as  a student,  I had  a hand- 
book of  that  kind,  but  it  very  frequently  happened  that  the 
subject  I was  engaged  in  dissecting,  had  none  of  the  diseases 
or  morbid  appearances,  that  the  page  I was  reading  referred 
to.  The  author,  indeed,  seemed  to  labour  under  the  pre- 
sumption that  the  young  anatomist  was  working  on  just  such 
a subject  as  he  had  in  view;  and  therefore  blended  his  mor- 
bid and  descriptive  anatomy  so  much  by  alternate  sentences 
for  each,  and  sometimes  in  the  same  sentence,  that  the  eye 
could  not  without  much  trouble,  distinguish  what  was  ap- 
propriate. A positive  inconvenience  was  thus  sustained. 

I have  been  concise  on  another  subject:  directions  how 
to  proceed  ; to  which  some  Anatomists  give  the  highest  im- 
portance, so  high,  indeed,  that  in  many  instances  the  sub- 
ject matter  is  lost  in  the  directions  how  it  is  to  be  found 
out.  In  the  opinions  of  some,  I may  here  have  committed 
a fault : my  general  intention  has  been,  in  all  cases,  to  as- 


PREFACE. 


IX 


sist  by  directions  where  the  novelty  and  obscurity  of  the 
operation  left  no  clew  for  the  student ; but  where  the  dis- 
section or  mode  of  examination  was  a plain  appeal  to  com- 
mon sense,  connected  with  the  common  powers  of  vision,  I 
have  thought  it  superfluous,  and  even  ridiculous  to  write 
down  what  was  to  be  done.  In  the  common  operation  of 
walking,  it  would  be  quite  philosophical  to  tell  a being  of 
another  world,  who  knew  nothing  of  this,  and  was  diffe- 
rently constituted,  that  it  was  accomplished  by  putting  one 
leg  before  the  other ; but,  perhaps,  there  is  no  human  being, 
in  the  rational  exercise  of  his  faculties,  who  would  thank 
any  one  for  such  information.  On  this  ground  I have  omit- 
ted many  directions ; but  it  is  not  improbable,  that  things 
which  seem  perfectly  plain  and  appreciable  to  one  in  the 
daily  exercise  of  Anatomy,  may  be  more  obscure  to  another 
less  occupied  with  it. 

It  will  be  seen  that  the  work  consists  of  three  Parts;*  the 
Head  and  Neck,  with  the  contained  organs,  form  one  part, 
the  Trunk  a second,  and  the  Extremities  a third.  The  di- 
vision is  obviously  artificial,  as  probably  every  other  plan 
must  be ; for  in  following  the  details  of  Anatomy,  it  is  im- 
possible to  avoid  chasms  in  the  description.  The  human 
body  is  a whole,  but  made  up  of  such  a multitude  of  parts 
that  no  mind  can  comprehend  or  receive  at  once  all  of  them. 
In  this  dilemma  each  writer  will  probably  have  an  arrange- 
ment, which,  to  him,  appears  better  than  all  others.  It  may 
be  asked,  why  I have  put  the  most  difficult  part  of  Anatomy 
first?  I answer,  that  it  is  only  first  to  him  who  chooses  to 
study  it  first.  The  plan  of  the  book  enables  the  student  to 
commence  with  either  of  the  parts,  with  nearly  equal  ad- 
vantage. In  adopting  it,  the  most  prominent  objection  to 
my  mind,  was  the  necessity  of  repeating  the  same  observa- 

* This  arrangement  has  been  slightly  altered  in  the  present  edi- 
tion but  not  in  such  a way  as  to  affect  the  general  plan. 


X 


PREFACE. 


lions  in  different  places.  In  writing  I have  had  this  con- 
tinually in  view,  and  though  it  could  not  always  be  avoided, 
I have  nevertheless  endeavoured  to  curtail  so  much  its  fre- 
quency, that  I trust  it  will  not  be  considered  a blemish  of 
much  magnitude. 

As  the  objects  of  this  book  are  limited  to  what  its  title 
page  proposes,  any  deficiency  in  it  must  be  made  up  by 
consulting  my  Treatise  on  Special  and  General  Anatomy, 
4th  Ed.  1836. 


Philadelphia,  1836. 


W.  E.  HORNER. 


P B E F A C E 


TO  THE 

FOURTH  EDITION. 


The  publication  of  the  present  work,  the  United  States 
Dissector,  twenty-three  years  ago,  under  the  title  of  Les- 
sons in  Practical  Anatomy,  presented  the  first  original  Ame- 
rican Manual,  devoted  to  the  purposes  of  the  dissecting 
room.  It  had  the  effect  of  wholly  suspending,  or  reducing 
materially,  the  demand  for  the  pi'eviously  current  productions 
of  a corresponding  kind,  and  which,  from  their  merit  and 
general  applicability,  had  justly  enjoyed  the  confidence  of 
dissectors.  Since  the  period  above  mentioned,  the  demand 
for  it  has  still  continued,  as  proved  by  the  exhaustion  of  suc- 
cessive editions,  in  the  midst  of  surrounding  publications, 
nearly  all  of  which  were  reprints  of  the  works  of  our  scien- 
tific brethren  abroad,  and  which  are  distinguished  by  their 
respective  attractions,  economical,  didactic,  or  illustrative. 
Under  these  circumstances,  the  publishers  have  been  induced 
to  bring  forward  a fourth  edition,  advanced  in  its  character,  by 
harmonizing  with  the  recent  progress  of  anatomical  science, 


XU 


PREFACE. 


and  by  the  introduction  of  explanatory  plates;  the  latter  a 
mode  of  illustration  now  so  general  and  so  popular,  that  it 
is  difficult  to  impart  currency  to  a work,  on  a demon- 
strative science,  without  that  addition.  With  this  novelty  of 
feature;  with  a carefully  revised  text ; and  with  a use  so 
widely  extended  as  to  have  reached  the  libraries  of  some 
thousands  of  the  well  educated  physicians  of  our  country;  it 
has  been  deemed  by  the  publishers,  not  inappropriate,  to 
adopt  also  a new  title. 

Under  the  above  explanations  the  duty  performed  by  the 
present  Editor  is  intelligible,  and  the  edition  is  submitted  to 
students,  and  to  the  medical  public,  with  a hope  that  it  may 
be  found  of  augmented  usefulness,  from  the  modifications 
that  it  has  undergone.  For  deficiencies  in  the  text,  pur- 
posely left,  the  reader  will  consult  the  Treatise  on  Special 
Anatomy  and  Histology,  by  the  Author,  Seventh  Edition, 
Philadelphia,  1846. 


Philadelphia,  June  24th,  1846. 


THE 


DISSECTOR. 


INTRODUCTION. 


ON  DISSECTING,  AND  ON  ANATOMICAL 
PREPARATIONS. 

The  dress  of  a student  for  the  dissecting  room,  should  be  an 
apron,  extending  from  the  neck  to  half-way  down  the  legs ; 
and  a pair  of  sleeves,  attached  to  the  apron  or  not,  accord- 
ing to  the  fancy  of  the  wearer.  It  should  be  so  loose  as  to 
give  him  perfect  freedom  in  all  his  motions.  His  instru- 
ments are  contained  in  a box,  called  a Dissecting  Case. 
They  should  consist  at  least  of  four  knives,  one  single  hook, 
one  double  hook,  one  pair  of  forceps,  one  pair  of  scissors,, 
one  bloJft-  pipe,  and  two  crooked  needles. 

Cleanliness  is  of  the  first  importance ; the  dissector  should, 
therefore,  never  suffer  his  table  to  become  foul  from  blood 
or  pieces  of  flesh  standing  on  it,  neither  should  he  suffer 
blood  to  remain  in  the  different  depressions  about  the  sub- 
ject, when  it  can  be  conveniently  got  out.  He  should  keep 
a sponge  for  himself,  for  where  a sponge  is  used  by  se- 
veral it  becomes  nobody’s  business  to  clean  it;  the  conse- 
quence is  that  it  is  seldom  fit  for  use.  When  the  integu- 
ments of  a subject  are  laid  open,  the  parts  exposed  either 
dry  or  putrefy  rapidly.  A constant  rule  is  hence  established 
not  to  turn,  down  more  skin  than  the  freedom  of  dissection 

o 


18 


INTRODUCTION. 


requires,  and  to  save  it  as  much  as  possible  to  cover  the 
parts  again,  when  the  dissection  is  suspended  for  an  inter- 
val. When  there  is  not  enough  of  it  for  this  purpose,  a 
damp  cloth,  several  folds  thick,  should  be  at  hand  to  assist 
in  covering. 

The  knife  should  be  held  like  a writing  pen  in  the  right 
hand ; when  muscles  are  dissected  it  should  be  exclusively 
used  for  cutting,  as  the  scissors  do  not  answer.  The  in- 
teguments of  the  parts  covering  the  muscles,  should  be  held 
perfectly  tense  with  the  other  hand,  or  with  the  forceps. 
The  knife  should  be  passed  with  a steady  and  light  stroke 
in  the  direction  of  the  muscular  fibres,  and  in  such  a way 
as  just  to  graze  them.  This  latter  rule  is  indispensable  ; 
no  one  can  dissect  a muscle  well  without  observing  it,  and 
it  should  be  continually  present  to  the  mind  of  the  student. 

In  order  to  dissect  with  comfort  or  neatness,  it  is  of  im- 
portance that  a good  edge  be  kept  on  the  scalpels  employed; 
and,  as  many  are  ignorant  of  the  proper  manner  of  sharpen- 
ing instruments,  the  following  directions  may  prove  use- 
ful. 

SETTING  SCALPELS.* 

“Bearing  in  mind,  that  a cutting  edge  is  the  apex  of  a cone, 
more  or  less  elongated,  it  will  be  easy  for  any  one  to  judge 
of  the  various  degrees  of  inclination  to  be  adopted  in  gliding 
the  knife  along  the  surface  of  the  hone — recollecting  that 
the  edge  is  to  be  kept  foremost,  so  as  to  gather  the  oil  spread 
on  previously.  This  must  be  done  alternately  to  each  side, 
holding  the  instrument  steadily,  but  still  with  a light  hand. 
If  it  is  to  be  used  for  cutting  dense  matter,  the  back  of  the 
scalpel  should  be  held  above  the  level  of  the  stone,  at  an 
angle  of  30  degrees  ; if  for  cutting  a delicate  membrane,  the 
back  should  be  held  so  as  to  touch.  It  is  a very  common 
practice  to  lay  on  heavily  when  setting : this  is  bad,  as  it 
has  a tendency  to  produce  a wire  edge  which  entirely  pre- 
vents the  instrument  from  cutting.  If  the  edge  should  be 

* Tulk  and  Henfrey,  Anat.  Manipulation,  London,  1844. 


INTRODUCTION. 


19 


blunt,  a Turkey  stone  is  to  be  used  first,  then  a German 
hone,  and  finally  a hard  green  stone,  (called  “ Charley 
Forrest”)  which  is  found  in  some  parts  of  England.  To 
instruments  not  much  blunted,  razor  paste  spread  on  a strap 
or  a piece  of  smooth  hard  wood,  will  give  a fine  edge.” 

In  the  United  States  the  Arkansas  Hone  or  whetstone  is 
justly  admired  for  its  fine,  sharp  grain,  and,  when  properly 
used,  renders  a finishing  strap  unnecessary. 

OF  INJECTIONS. 

Swammerdam  first  used  wax  injections,  and  about  the 
year  1672.  Corroded  preparations  were  first  made  by 
Francis  Nicholls,  Professor  of  Anatomy  at  Oxford,  about  the 
beginning  of  the  last  century.  Rouhaut,  a surgeon  of  the 
king  of  Sardinia,  first  dissolved  glue  to  inject  small  vessels 
wdtfi.  Homberg  of  Paris,  proposed  a mixture  of  equal  parts 
of  tin,  bismuth  and  brass,  wdierewith  to  inject  blood-vessels 
by  means  of  a pneumatic  apparatus  for  forcing  it  in. 

There  are  three  kinds  of  injections  in  use  among  anato- 
mists, the  Coarse,  the  Fine,  and  the  Minute ; which  are  ap- 
plied to  the  filling  of  the  arteries  and  of  the  veins,  in  order 
to  demonstrate  their  course  more  satisfactorily. 

For  Coarse  Injections,  select  from  the  following  Formulae : 
No.  I. 

Yellow  Bees-Wax,  pure  ibi. 

Bleached  Rosin,  IbR 

Turpentine  Varnish,  by  measure,  gvi.* 

Mix. 

No.  II. 

Yellow  Rosin,  tfei. 

Yellow  Bees-Wax,  tbU 

Turpentine  Varnish,  a sufficient  quantity  to  make 
the  mixture  flexible  when  cold.f 

Mix. 


* Fyfe,....Pole. 


f Nicholls. 


20 


INTRODUCTION. 


No.  III. 

Tallow,  tbi. 

White  Wax,  gv. 

Common  Oil,  ^iij. 

Venice  Turpentine,  or  Rosin  ?ii.* 

Mix. 


No.  IV. 

Common  Rosin. 

Beef  Tallow.. 

Bees-Wax,  of  each  flyL 

Mix. 

This  mixture  penetrates  well,  and  having  some  flexibility 
in  the  winter,  withstands  the  warm  weather  in  summer. 


For  making  either  mixture,  Red ; add  Vermilion  ^iij. 


do.. 

do. 

Yellow;  King’s  Yellow,  ^ijss. 

do. 

do. 

White;  Best  Flake  White,  jvss.  ’ 

do. 

do. 

Pale  Blue ; 5 Best  Fiake  White, Jiijas. 

^Fine  Blue  Smalt,  ^iijss. 

do. 

do. 

Dark  Blue;  Blue  Verditer,  jxss. 

do. 

do. 

Black;  Lamp-Black,  ^i. 

f Powdered  Verdigrise,  jivss. 

do. 

do., 

Green;  < Best  Flake  White,  ^iss. 

( Gamboge,  powdered,  ^i. 

No..  V.f 

Beef  Tallow,  tbij. 

Calcined  Magnesia,  ^ss. 

Chinese  Vermilion,  ~i. 

Mix. 


Liquify  the  above  mixtures  over  a slow  fire,  or,  what  is 
still  better,  in  a water  bath. 

* Monro. 

t Dublin  Dissector.  This  is  a good  injection  and  may  be  used  to 
some  extent,  without  previously  heating  the  subject* 


INTRODUCTION. 


21 


No.  VI. 

When  the  student  wishes  only  to  prosecute  the  dissection 
of  the  vessels  without  making  a preparation  of  them,  the 
following  injection  will  answer: 

Tallow,  tfeij- 

Turpentine  Varnish,  3x. 

Red  Lead,  3viij. 

Mix. 

This  mixture  retains  its  fluidity,  when  melted,  for  a long 
time;  and  may  be  thrown  from  the  arch  of  the  aorta  through 
the  primitive  and  many  of  the  secondary  arterial  trunks, 
without  heating  the  subject.  Its  cheapness  makes  it  very 
advantageous. 

The  success  of  this  injection  will  be  increased  by  throw- 
ing in  first,  a syringe  full  of  No.  IX.  or  X.  properly  heated, 
with  a view  of  warming  somewhat  the  vessels  and  removing 
their  rigidity. 

No.  VII. 

A commodious  formula,  and,  for  the  most  part,  a very 
successful  one,  has  been  in  use  amongst  us  for  many  years. 
It  is  also  much  approved,  I have  understood,  in  other  parts 
of  the  United  States,  and  is  commonly  called  the  Cold  In- 
jection from  its  not  being  necessary  to  heat  it.  To  make 
this  mixture,  take 

White  Lead  and  Red  Lead,  of  each  3iv. 

Linseed  Oil  enough  to  form  a thick  paste  by  rubbing  them 
well  together.  Liquefy  this  paste  with  Turpentine  Varnish, 
3viij. 

Just  before  injecting,  sprinkle  the  mixture  with  cold  wa- 
ter. The  advantage  of  it  is,  that  it  does  not  require  the 
subject  to  be  previously  heated.  The  colour  may  be  im- 
proved with  vermilion.  As  making  a mixture  for  each 
time  one  has  to  inject,  is  rather  troublesome,  a larger  quan- 
tity of  the  ingredients,  with  the  exception  of  the  varnish, 
may  be  blended,  and  then  kept  fluid  for  a long  period  by 


22 


INTRODUCTION. 


pouring  water  into  the  vessel.  After  the  varnish  is  once 
added,  the  mixture  must  be  used  immediately,  as  it  then 
begins  to  thicken.  This  is  a very  popular  injection,  and 
several  persons  have  supposed  themselves  to  be  the  inven- 
tors of  it.  I have  been  informed  by  the  Right  Rev.  Bishop 
Onderdonk,  of  Pennsylvania,  in  early  life  a physician;  he 
having  studied  under  the  celebrated  Dr.  Post  of  N.  Y.  that 
it  originated  with  Mr.  Allan  Ramsay,  a Scotch  Anatomist. 

These  ingredients  are  used  in  various  proportions  by 
different  anatomists,  and  it  may  be  found  advantageous  to 
increase  or  diminish  their  relative  quantity  according  to 
circumstances.  The  Red  Lead  is  more  drying  than  the 
White,  and  is  sometimes  used  without  the  other,  as  fol- 
lows : 

No.  VIII. 

Red  Lead. 

Linseed  Oil  sufficient  to  bring  it  to  the  consistence  of  putty. 

Then  equal  parts  of  Spirits  of  Turpentine  and  Turpentine 
Varnish,  until  it  is  reduced  to  a semifluid  state. 

Just  before  injecting,  sprinkle  it  with  a little  water  and  stir  it.* 

White  Lead,  treated  in  the  same  way  wTith  linseed  oil  and 
turpentine  varnish,  may  have  its  colour  changed  to  fancy,  by 
any  of  the  colouring  matters  mentioned.  It  is  not  necessary 
to  strain  these  lead  mixtures. 

For  Fine  Injections  take  the  following: 


No.  IX. 

Brown  Spirit  Varnish,  ~iv. 

White  Spirit  Varnish,  ^iv. 

Turpentine  Varnish,  >p. 

Mix  and  heat. 

* Charles  Bell’s  system  of  Dissections,  London,  1809. 


INTRODUCTION. 


23 


To  make  this 
do. 
do. 

do. 

do. 
do. 

Or,  No.  X. 

According  to  Dr.  Monro,  a Fine  Injection  may  be  ob- 
tained, by  pouring  oil  of  turpentine  on  any  finely  powdered 
colouring  matter,  till  it  reaches  a proper  consistence. 

For  Minute  Injections  take  the  following: 

No.  XI. 

Most  transparent  Glue,  broken  to  pieces,  or  Isinglass,  “ viij . 
Water,  Fbiss. 

Mix. 

Let  it  stand  till  the  glue  is  soft,  which  will  take  from  one 
to  two  days.  Then  heat  it  gently  till  the  consistence  is 
uniform,  or  a perfect  size  is  made.* 


To  make  this 

mixture  Red;  add  Vermilion,  rv. 

do. 

do. 

Yellow;  King’s  Yellow,  jiv. 

do. 

do. 

White  ; Best  Flake  White,  ^v. 

do. 

do. 

Blue;  Fine  Blue  Smalt,  jviij. 

do. 

do. 

f Powdered  Verdigrise  ?iij 

do. 

do. 

Green;  < Best  Flake  White,  jjij. 

do. 

do. 

( Gamboge  powdered,  “ij. 

do. 

do. 

Black ; Lamp-Black,  ~i. 

* The  Isinglass  is  much  more  expensive,  but  more  minute. 

glue  varies  much  in  strength,  this  quantity  of  water  must  on  some 
occasions  be  reduced,  I find  it  a good  rule  after  soaking  the  glue  to 
pour  off  the  free  water. 


mixture  Red;  add  Vermilion,  ^i. 

do.  Yellow;  King’s  Yellow,  ^i|. 

do.  White;  Best  Flake  White,  ^'j- 

, T • n,  CFine  Blue  Smalt,  ziss. 

do.  Light  Blue ; -2  u 

cBest  Flake  White,  "i|. 

do.  Dark  Blue;  Blue  Verditer,  ^iv. 

do.  Black;  Lamp  Black,  ijss. 


24 


INTRODUCTION. 


Or,  No.  XII. 

MINUTE  INJECTION  OF  PROFESSOR  BERRES.* 

Copal  Varnish  prepared  with  Alcohol. 

Gum  Mastich  dissolved  in  about  the  sixth  part  of  Spirits  of 
Turpentine.  Equal  parts. 

Mix. 

These  materials  are  brought  by  gentle  heat  to  a proper 
consistence,  which  may  be  known  by  letting  a drop  fall 
upon  a stone.  If  the  drop  be  quickly  reduced  to  a homo- 
geneous, pure,  honey-like  mass,  tenacious  and  ductile,  it 
is  fit  for  injections. 

The  mass  is  then  to  be  made  of  a suitable  colour  with 
factitious  cinnabar  of  the  best  quality,  rubbed  down  with 
spirits  of  turpentine.  This  mixture  must  be  well  strained 
into  a warm  vessel,  and  its  heat  sustained  in  a sand  bath 
at  the  time  it  is  used. 

When  veins  and  arteries  are  both  injected  the  veins 
precede. 

The  injection  finished,  the  parts  are  to  be  immersed  at 
once  in  cold  water  and  retained  until  their  temperature  is 
settled. 

Parts  thus  prepared  exhibit  the  smallest  vessels  turgid 
and  sufficiently  hard,  to  be  dissected  without  the  injection 
flowing  out.  They  present  an  agreeable  appearance  and 
are  most  convenient  for  the  microscope.  For  a long  series 
of  years  they  increase  in  beauty  and  elegance,  by  the  eva- 
poration of  the  fluid  materials  of  the  injection  and  the  dry- 
ing of  the  part  itself,  exposing  more  and  more  the  turns  of 
the  turgid  vessels. 

When  there  are  vessels  too  fine  to  be  filled  with  the 
above,  Professor  Berres  recommends  a preparatory  injec- 
tion of  spirits  of  turpentine  or  of  glue,  brought  to  a proper 
colour.  It  answers  very  well  to  draw  first  into  the  syringe 
some  of  the  resinous  injection,  and  in  the  second  place  the 
other.  In  its  expulsion  the  finest  injection  will  return  first 
and  be  followed  immediately  by  the  other. 


* Anatomia  Partium  Mieroscopicarum  Corporis  Humani,  p.  23. 
Vienna,  1836. 


INTRODUCTION. 


25 


In  all  of  these  formulae  for  Injections,  it  is  of  the  utmost 
importance  to  success  in  the  use  of  them,  to  have  the 
colours  in  the  purest  condition  and  reduced  to  the  finest 
powder  by  levigation  or  trituration.  In  Philadelphia  they 
are  found,  for  the  most  part,  in  a state  fit  for  use  in  the 
Druggist’s,  and  Painter’s  and  Glazier’s  shops.  But  to  ren- 
der the  process  still  more  certain,  it  is  better  to  strain  the 
mixtures,  after  the  colours  are  added,  (the  cold  injections 
excepted)  through  a fine  flannel  cloth,  which  will  arrest  the 
impurities  both  in  the  original  mixture  and  in  the  colouring 
ingredients. 

In  the  use  of  the  first  four  formulae,  it  is  indispensable  to 
warm  the  subject  thoroughly  by  previous  immersion  in  water 
hot  enough  to  excite  the  sensation  of  scalding  in  the  finger, 
say  at  from  1 1 0 to  1 1 5°  Fahr.  If  the  water  be  too  warm,  it  will 
cause  the  parts  to  contract  and  to  become  rigid  instead  of 
softening  them.  The  injection  must  be  of  the  same,  or  even 
of  a somewhat  higher  temperature. 

No.  I.  is  used  for  corroded  and  dried  preparations.  Nos. 
II.  III.  IV.  and  V.  for  the  latter  alone.  Nos.  VII.  and  VIII. 
answer  remarkably  well  for  dried  preparations  but  are  very 
brittle;  it  takes  about  twenty-four  hours  to  harden  them ; the 
part  injected  should,  therefore,  not  be  disturbed  till  the  ex- 
piration of  that  period.  No.  IX.  or  X.  is  sometimes  used 
as  the  precursor  to  the  three  first.  No.  XI.  is  adapted  to 
wet  preparations  and  such  as  are  intended  to  demonstrate 
minute  vascularity. 

The  student  acquainted  with  the  circulation  of  the  blood 
will  always  know  where  to  fix  his  pipes  when  an  injection 
is  to  be  accomplished,  whether  arterial  or  venous,  or  both. 
It  is  therefore  unnecessary  to  extend  this  notice  by  describing 
the  method  of  proceeding  in  each  individual  preparation, 
general  rules  being  sufficient,  and  to  the  intellectual  mind 
much  more  acceptable. 

The  more  limited  the  range  of  an  injection  is,  the  more 
likely  it  will  be  to  succeed  well,  as  the  force  of  the  syringe 
is  thereby  concentrated.  Hence  a rule  is  established  to  put 
the  pipe  as  near  as  possible  to  the  part  intended  to  be  in- 
jected. 


26 


INTRODUCTION. 


MEANS  FOR  THE  PRESERVATION  OF  SUBJECTS 
FOR  DISSECTION. 

Various  plans  and  substances  have  been  proposed  for  this 
very  desirable  object,  but  there  are  none,  as  yet  made  known, 
which  meet  every  requisite.  Antiseptic  articles  are  suffi- 
ciently abundant,  it  is  true,  and  will  be  found  in  many  of 
the  metallic  and  alkaline  preparations.  The  most  prominent 
among  the  former  are  white  oxide  of  arsenic  and  muriate  of 
mercury,  and  among  the  latter  are  muriate  of  soda,  nitrate 
of  potash,  muriate  of  ammonia,  the  aluminous  salts  and  some 
others.  There  are  very  few  neutral  salts  indeed,  which  do 
not  possess  to  a limited  extent,  this  property.  Alcohol 
and  its  several  preparations  are,  in  many  respects,  unexcep- 
tionable. We  also  have  the  various  vegetable  and  mineral 
acids : creasote,  the  essential  oils,  especially  that  of  the  pinus 
sylvestris,  elain  and  stearin,  &c.  &e.  The  catalogue  is, 
indeed,  very  numerous,  of  articles  having  a power  to  resist 
the  decomposition,  by  putrefaction,  of  animal  matter.  A 
substance,  however,  to  be  unexceptionable,  must  possess  an 
absolute  antiseptic  property — it  must  not  vitiate  the  colour 
of  organs,  neither  must  it  affect  their  texture  so  as  to  alter 
materially  or  objectionably  their  consistence ; and,  last  of 
all,  it  should  resist  the  process  of  drying,  so  that  parts  will 
remain  flexible  and  of  full  volume  as  in  life.  It  is  difficult 
to  say,  whether  any  anatomist  has  succeeded  in  his  art  to 
the  degree  of  perfection  thus  demanded.  If  the  accounts  of 
Ruysch  and  his  preparations  be  not  exaggerated,  he  would 
seem  to  have  accomplished  all  of  these  points,  but  by  what 
process  is  now  entombed  with  him. 

Having  tried,  to  some  extent,  nearly  all  the  principal 
articles  in  the  foregoing  category,  my  preferences  have  set- 
tled down  decidedly  in  favour  of  two  or  three  of  them,  to 
wit,  the  muriate  of  soda,  nitrate  of  potash,  and  alcohol.  The 
two  former  for  the  preservation  of  bulk)'  articles,  by  injection 
and  by  external  application, — the  latter  by  steeping. 

The  formula  which  I have  now  used  for  twenty-five 
years,  with  some  slight  changes,  as  experience  directed,  is 
as  follows : — 


INTRODUCTION. 

27 

Liverpool,  St.  IJbes, 
or  Turks’ Island  Salt, 

^xxxvi.,  avoirdupois. 

Nitrate  of  Potash,  .... 

^xix.,  “ 

Carbonate  of  Soda, 

Sviii.,  “ 

Molasses,  (sugar-house,) 

5iv.,  by  measure. 

Starch, 

Water, 

5ij' 

Ovi. 

Mix. 

In  the  preparation  of  the  above,  which  is  sufficient  for  one 
subject,  the  saline  constituents  are  to  be  thoroughly  dissolved 
first  of  all  in  the  wrater  boiling.  The  molasses  is  afterwards 
stirred  well  in.  The  starch  should  be  first  mixed  up  with 
cold  water,  Oss.,  and  the  lumps  fully  reduced;  in  that  state 
it  is  stirred  gradually  in  with  the  other  articles,  and,  as  soon 
as  they  begin  to  boil  again,  the  whole  mass  swells  up,  and 
in  that  state  should  be  immediately  removed  from  the  fire: 
on  the  proper  reduction  of  its  temperature,  it  is  then  fit  for 
use.  I generally  make  several  gallons  of  this  mixture  at 
once,  to  have  it  at  hand,  but  its  quality  is  somewhat  im- 
paired by  keeping.  The  molasses  develops  a fine  aroma 
at  the  boiling  temperature  of  this  solution,  and  the  starch 
imparts  a proper  consistence.  The  soda  prevents  instru- 
ments from  being  readily  acted  on  by  the  compound.  Any 
one  or  more  of  the  above  ingredients  may  be  increased  or 
diminished  from  their  relative  quantity  to  meet  especial  in- 
tentions. Some  regard  must  be  had,  however,  to  the  muri- 
ate of  soda  and  the  nitrate  of  potash,  as  any  great  excess 
above  the  quantities  stated,  in  going  too  far  beyond  the  point 
of  saturation,  will  make  a simple  mixture  clogged  by  the 
uncomminuted  and  undissolved  particles.  If  the  desire  be 
to  colour  up  the  muscles  very  highly,  the  molasses  may  be 
used  more  freely ; if  the  appearance  of  the  nerves  and  of  the 
white  tissues  is  to  be  preserved,  the  quantity  may  be  de- 
creased to  a minimum.  The  soda  may  be  left  out  entirely, 
but,  when  in,  it  has  the  property  of  preventing  the  main  in- 
gredients from  hardening  too  much  the  tissues  injected.  If 
the  subject  to  be  injected  is  loose  and  somewhat  oedematous, 
the  mixture  should  be  made  thicker  with  starch,  the  object 
of  the  latter  being  to  regulate  percolation. 

The  best  way  of  introducing  the  above  mixture  is  as  fol- 


28 


INTRODUCTION. 


lows : The  sternum  should  be  divided  longitudinally  through 


mixture ; but  the  best  way  is  by  a column,  of  twelve  or 
eighteen  feet  in  height,  to  which  for  convenience  is  attached 
a flexible  tube  of  leather  of  four  feet  in  length,  to  conduct 
the  injection  to  the  aorta  pipe;  and  furnished  with  a stop 
cock  at  the  lower  end.  By  this  apparatus,  the  pressure  can 
be  so  exactly  regulated,  as  to  keep  the  vessels  full  without 
rupturing  them,  and  the  injection  be  pushed  uniformly  on.  In 
all  cases  where  it  succeeds  well,  it  returns  by  the  veins,  and 
keeps  them  beautifully  distended  as  in  exercise.  It  should 
be  thrown  in  warm. 

Injection  through  one  of  the  collateral  arterial  trunks  is 
not  so  effectual  as  from  the  aorta  itself.  I have,  for  the 
purpose  of  saving  the  sternum,  tried  the  brachial,  the  femo- 
ral, the  carotid  and  some  other  arteries,  but  always  with 
some  measure  of  disappointment. 

If  the  subject  is  to  be  used  immediately,  the  above  quan- 
tity will  hold  it  in  good  preservation  for  two  months  in 
winter ; if  it  is  to  be  kept  during  the  summer  and  for  an 
indefinite  length  of  time,  twice  the  quantity  should  be  in- 
jected; or  even  more  if  the  subject  be  very  large.  The 
objection  to  using  the  latter  quantity  where  a subject  is  to 
be  dissected  at  once,  is,  that  it  inundates  rather  too  much, 
but  where  time  is  left  for  evaporation,  the  latter  process  cor- 
rects the  over-humidity. 

If  a subject  is  to  be  kept  during  the  whole  summer,  it 


i mwmr 


its  middle,  and  to  get  at  the  heart 
the  Sternum  Dilator?  the  instru- 
ment, represented  in  the  adjoin- 
ing figure,  to  which  I called  the 
attention  of  the  profession  some 
years  ago,*  should  be  used.  The 
two  divisions  of  the  instrument, 
acting  each  upon  its  side  respec- 
tively of  the  sternum,  the  latter, 
parts  open  four  or  five  inches. 
The  pericardium  is  then  slit  up, 
and  a large  pipe  introduced  into 


- a the  root  of  the  aorta.  A syringe 


will  do  for  throwing  in  the 


* Vol.  iii.  p.  242,  Am.  Journ.  Med.  Sc.,  Nov.  1828. 


INTRODUCTION. 


29 


should  be  preserved  besides  in  a mixture  of  one  part  of 
common  salt  to  four  of  mahogany  or  pine  sawdust ; and,  to 
prevent  its  becoming  too  dry,  it  should  be  sealed  up  in  lead, 
or  surrounded  by  a cloth  which  is  impenetrable  to  moisture, 
or  by  some  other  of  the  numerous  means  of  insulation  from 
the  atmosphere,  as  a box  covered  well  with  pitch,  or  an  old 
oil  barrel  or  hogshead.  A subject  may  be  kept  in  this  way, 
fit  for  most  anatomical  purposes,  for  an  indefinite  length  of 
time.  If  the  investment  used  fail  in  preventing  evaporation 
and  the  limbs  get  hard,  they  maybe  soaked  out  to  a proper 
suppleness.  Insects  have  no  disposition  to  molest  such 
pieces  in  their  dried  state. 

The  above  injection  impairs  the  great  nervous  centres,  as 
the  brain  and  spinal  marrow  ; also  the  mucous  membranes 
and  the  rete  mucosum,  by  softening  them  and  making  them 
pulpy ; a proof  by  the  way  of  the  quantity  of  neurine  and 
nervous  fatty  matter  entering  into  the  composition  of  the 
rete  mucosum.  This  influence  is  derived  from  the  free 
alkaline  matter  in  the- injection,  coalescing  with  the  neurine, 
and  making  a half  diffluent  soap.  Hence  the  cuticle  always 
parts  in  ten  or  twelve  days.  Leaving  the  alkali  out  will 
correct  this,  but  with  another  disadvantage  in  its  place,  to 
wit,  the  too  great  hardening  of  the  tissues.  The  accident 
is,  at  best,  but  unimportant,  as  a roller  imbued  with  tallow 
or  wax,  laid  down  in  place  of  the  cuticle,  will  resist  the 
drying  of  the  skin  at  the  part. 

The  muscles  are  beautified  to  a remarkable  degree  by  the 
above  injection,  and  are  also  preserved  in  a fine  state  ofi 
strength  and  tonicity.  I resort  to  it  invariably  in  my  de- 
monstrations of  the  muscles,  and  have  done  so  since  its 
first  adoption,  and  should  consider  my  arrangements  incom- 
plete without  it.  Whether  my  partiality  is  justified,  must 
however,  depend  more  upon  the  evidence  of  some  thou- 
sands of  young  men,  who  have  been  trained  in  their  anatomy 
by  me. 

Anatomical  pieces  preserved  this  way,  do  not  make  good* 
spirits  of  wine  preparations  for  suspension ; the  salts  and  the 
molasses  are  constantly  tinging  that  fluid.  If  the  pieces  are 
to  be  shown  by  direct  handling,  the  turbidness  of  the  fluid 
is  inconsequential,  and  the  muscular  fibre,  though  its  colour 
is  changed  by  the  spirits  of  wine  into  a dark  olive,  yet  has 
its  character  very  strongly  developed  in  parts  where  it  may 


30 


INTRODUCTION. 


previously  have  been  equivocal.  The  fibre  is  also  rendered 
somewhat  more  brittle,  and  the  cellular  substance  more  dis- 
tinct by  it.  A muscle  thus  treated,  becomes  a fine  subject 
for  unravelling  and  for  study.  The  arteries  distended  in 
this  way,  are  for  a short  time  rendered  very  soft  and  exten- 
sible, and  receive  then  a much  fuller  amount  of  the  common 
coarse  injections.  Some  delay  should  he  had  before  the 
latter,  so  as  to  allow  the  antiseptic  injection  to  pass  on,  and 
the  aorta  should  at  any  rate  be  emptied  of  it.  This  injection 
has  a fine  effect  in  developing  the  tissue  of  an  artery,  espe- 
cially if  the  latter  be  steeped  afterwards  in  alcohol. 

The  skeleton,  the  ligaments  and  the  cartilages,  are  made 
extremely  firm  by  the  injection  above,  so  that  in  boiling,  the 
gelatin  is  not  formed  so  readily ; and  maceration  in  water 
seems  to  produce,  even  in  very  hot  weather,  scarcely  any 
effect  in  accelerating  the  putrefaction  of  these  parts.  Skele- 
tons thus  injected,  though  much  more  durable  and  heavy, 
when  prepared  by  boiling,  than  others ; yet  never  can  be 
well  bleached,  but  always  retain  a brown  tinge. 

Upon  a dissected  surface  a soapy  glairy  formation  will 
occur  after  a few  hours  exposure  to  the  air : this  may  be 
partially  corrected  by  an  envelop  saturated  with  tallow,  or 
with  molasses  and  water. 

As  to  the  vaunted  preparations  of  arsenic,  they  are  cer- 
tainly, antiseptic,  but  poison  the  dissector’s  fingers,  add 
nothing  to  the  qualities  of  the  parts  for  dissection,  and  indeed 
rather  impair  them.  The  Sulphate  of  Alumina  recommended 
by  Mr.  Gannal  of  Paris,  is  also  antiseptic,  like  all  the  other 
forms  of  this  earth,  but  spoils  completely  the  colour  of  the 
muscles,  and  also  hardens  them  and  other  parts  too  much. 
It  has  in  this  respect  a similar  effect  to  corrosive  sublimate, 
which  of  all  articles  is  the  most  potent,  both  for  preventing 
and  for  arresting  putrefaction;  but  like  arsenic  exposes  the 
health  of  the  operator,  and  also,  by  its  ready  action  upon 
the  albuminous  constituent  of  our  tissues,  confounds  them 
all  into  a hard,  drab-coloured  undistinguishable  texture. 

I will  make  a few  remarks  on  alcohol,  or  spirits  of  wine, 
from  my  own  observation.  There  is  no  other  fluid  which 
I think  equal  to  it  for  wet  preparations ; and  those  who 
claim  for  the  dilute  acids,  and  tire  solutions  of  neutral  salts 
an  equal  value,  have  overlooked  too  much  the  constant  pre- 
cipitating of  their  solid  constituents,  so  as  to  obscure  the 


INTRODUCTION. 


31 


preparation  and  make  the  fluid  finally  turbid ; at  least  I 
have  tried  none  against  which  this  objection  did  not  hold. 
When  alcohol  is  used,  the  blood  should  be  removed  from 
the  specimen  by  soaking  it  for  a time  in  fresh  clear  water, 
frequently  changed ; then  at  least  three  times  its  wTeight  of 
alcohol  should  be  taken  and  the  specimen  so  arranged  that 
the  alcohol  shall  be  in  contact  with  its  whole  surface : mas- 
sive pieces  should  be  cut  into,  to  give  to  the  alcohol  a pro- 
per access.  When  the  preservation  of  the  white  tissues  is 
concerned,  the  alcohol  is  very  exactly  suited  to  them.  My 
most  usual  strength  of  it  is  about  26°  of  the  glass  float  of 
Cartier,  or  60°  of  the  centesimal  float  of  Gay  Lussac.  A 
bulky  anatomical  specimen,  from  the  quantity  of  water  it 
discharges,  will  dilute  the  spirits  of  wine  probably  six  or 
eight  degrees,  but  at  least  several,  and  a great  state  of  di- 
lution always  incites  to  softening  and  maceration,  so  as  to 
spoil  the  piece. 

A good  spirits  of  wine  preparation,  properly  made  and 
suspended,  is  constantly  improving  in  the  perfection  of  its 
appearance;  and  is  decidedly  better  at  the  end  of  twenty 
years,  than  at  the  beginning  of  them,  so  far  as  the  condition 
and  aspect  of  the  tissues  are  concerned.  Alcohol  can 
generally  be  got  of  the  strength  named,  at  seventy  cents  a 
gallon ; it  is  therefore  not  very  expensive  in  this  country, 
to  keep  up  anatomical  cabinets  of  wet  preparations.  In 
Europe,  the  excise  duties  impose  a much  higher  price,  and 
the  anatomists  are,  therefore,  constantly  attempting  to  adopt 
a cheaper  substitute. 

Wet  preparations  should  be  exposed  freely  to  the  light  of 
the  sun,  otherwise  their  texture  is  injured  by  its  absence,  and 
they  acquire  a dark  ugly  drab  colour;  this  is  especially  the 
case  with  ligamentous  tissues,  and  with  the  great  nervous 
centres. 

It  is  difficult  to  get  glass  or  stone  vessels  of  sufficient 
size  for  large  anatomical  pieces,  to  be  kept  in  spirits  of  wine. 
Vats  of  lead  are  used  to  some  extent,  but  a carbonate  of 
lead  is  formed  in  great  quantity,  which,  being  precipitated 
on  the  specimen,  spoils  its  surface,  and  makes  it  ragged 
and  opaque.  I have  tried  zinc  partially  and  find  it  to  answer 
better,  but  time  is  wanted  to  mature  the  observation.* 

* American  Journal  of  Medical  Sciences,  No.  xvii.  Jan.  1845, 
p.  245. 


32 


INTRODUCTION. 


DRIED  PREPARATIONS. 

Whenever  a section  of  the  body,  as  the  head,  the  arm, 
leg,  or  any  other  part,  is  to  be  injected,  the  arterial  pipe 
must  be  fixed  into  its  principal  trunk  or  trunks : and  the 
venous  pipe  into  one  of  the  extreme  branches.  A very 
common,  and,  indeed,  the  most  frequent  source  of  disappoint- 
ment to  the  young  anatomist,  is  the  neglecting  to  take  up 
such  vessels  as  were  cut  in  the  separation  of  the  part.  It 
may  be  avoided  by  blowing  into  the  pipes  when  fixed, 
whereby  all  the  ramifications  being  inflated,  such  as  are  cut 
can  be  thus  easily  found  out  and  secured. 

Male  subjects,  from  birth  till  the  age  of  twenty- five  or 
thirty,  answer  best  for  dried  preparations  of  the  greater  part 
of  the  arterial  system.  After  thirty,  few  subjects  answer 
well  in  consequence  of  a profusion  of  adeps  blending  itself 
with  the  muscles,  and  not  unfrequently  of  a diseased  state 
of  the  arterial  system. 

In  dried  preparations  the  arteries  should  be  fairly  traced 
in  all  their  ramifications,  and  the  muscles  separated  from 
each  other.  Every  thing  not  essential  to  the  object  of  the 
preparation  must  be  cut  away.  When  the  part  is  fully  dis- 
sected, care  should  be  taken  to  put  every  portion  of  it  in  a 
proper  posture,  and  to  fix  it  so  till  it  becomes  stiff  by  ex- 
posure to  the  air.  The  muscles  are  to  be  kept  asunder  by 
strips  of  wood. 

When  the  preparation  is  thoroughly  dried,  and  not  be- 
fore, it  should  be  varnished.  But  previously  to  the  latter  pro- 
cess, it  should  be  washed  twice  with  a solution  of  caustic 
potash,  in  order  to  remove  a greasy  coat  which  it  is  apt  to 
form  on  its  surface.  It  should  afterwards  be  washed  with 
water  to  remove  the  soap  that  results  from  the  application 
of  the  potash.  Soap-boiler’s  ley  answers  perfectly,  in  the 
place  of  the  caustic  potash  of  the  shops.  Dried  prepara- 
tions suffer  much  from  insects,  and  the  best  security  for 
them  is  obtained  by  immersion  in  a solution  of  corrosive 
sublimate,  till  they  become  impregnated  with  it ; they' may 
afterwards  be  put  in  position  and  dried.  If  they  are  too 
large  to  subject  to  this  process,  even  after  they  are  dried, 


INTRODUCTION. 


33 


they  may  be  washed  four  times  advantageously  with  this 
solution : 

Corrosive  Sublimate,  5b 

Muriate  of  Ammonia,  3iss. 

Water,  fbi. 

At  the  last  two  washings  add  to  the  foregoing, 

Common  Glue,  dissolved,  gi. 

The  glue  makes  the  solution  adhere  to  the  preparation, 
and  also  furnishes  for  the  varnish  a basis  or  ground,  which 
causes  it  to  stick  and  dry  well.  Two  thin  coats  of  copal 
varnish  must  afterwards  be  laid  on  with  a soft  brush. 

Copal  varnish  will  take  up  a small  quantity  of  corrosive 
sublimate,  hence,  I find  it  in  many  instances  sufficient  to  re- 
sort to  that  coating,  from  the  aversion  the  insects  have  to  it. 

To  make  a preparation  which  will  show  perfectly  the 
shape  and  communication  of  the  air  cells  of  the  lungs,  the 
lung  should  be  previously  filled  through  the  bronchus  with 
melted  tallow'.  When  the  latter  cools,  the  lung  should  be 
cut  into  thin  slices  and  dried.  The  pieces  are  then  to  be 
digested  for  some  days  in  spirits  of  turpentine  at  the  tempe- 
rature of  about  110°  so  as  to  dissolve  out  the  tallow. 
Should  the  blood-vessels  of  the  lung  have  been  minutely 
injected  with  size  previously,  a most  brilliant  set  of  prepa- 
rations can  be  made,  which  may  be  mounted  either  in  the 
dry  state,  or  suspended  in  spirits  of  turpentine. 

CORRODED  PREPARATIONS. 

The  heart,  lungs,  liver,  spleen,  pancreas,  kidneys,  and 
penis,  are  most  commonly  chosen  in  making  corroded  pre- 
parations. Their  vessels,  excretory  ducts,  and  cavities,  as 
the  case  may  be,  should  be  distended  moderately  with  No. 
I.  observing  to  give  to  each  system  in  the  structure  of  the 
viscus,  a colour  different  from  the  rest.  The  successful  in- 
jection of  these  requires  good  management,  because,  if  too 
much  forc^  be  used,  extravasation  will  occur,  and  the  pre- 
paration will  be  materially  disfigured. 

After  injecting  it,  the  preparation  is  to  be  laid  in  a mix- 

3 


34 


INTRODUCTION. 


ture  of  three  parts  of  muriatic  acid,  with  one  of  water, 
which  corrodes  the  fleshy  part  and  leaves  the  injection  ex- 
posed. The  process  of  corrosion  occupies,  from  three 
weeks  to  two  months,  according  to  the  bulk  of  the  viscus. 
The  acid  becomes  weakened  during  the  time,  and  we 
should,  therefore,  every  week,  add  enough  of  the  fresh,  to 
bring  the  mixture  to  its  original  strength. 

When  the  animal  part  is  converted  into  a soft  pulp,  the 
preparation  must  be  taken  out  of  the  mixture  with  the 
greatest  care  and  subjected  to  a small  gentle  stream  of 
water,  which  washes  off  the  pulp  and  leaves  the  vessels 
bare.  If  the  corroding  process  be  unfinished,  the  part 
must  be  replaced  in  the  acid  mixture  and  kept  there  till  it 
is  completed.  On  the  pulp  being  removed,  let  the  prepa- 
ration, remain  floating  in  water  for  twenty-four  hours,  in  or- 
der to  remove  any  acid  which  may  adhere  to  it ; then  dry 
it  by  suspension  in  the  air,  or  by  laying  it  on  a heap  of  soft 
carded  cotton  covered  with  a thin  cambric  cloth,  to  pre- 
vent the  cotton  from  sticking  to  its  vessels. 

The  preparation  should  be  fixed  on  a pedestal  of  plaster 
of  Paris,  and  coated  by  dipping  it  into  copal  varnish,  di- 
luted with  one  half  of  its  quantity  of  spirits  of  turpentine.  It 
should,  after  drying,  be  varnished  in  the  same  way  once 
more.  Such  preparations,  when  kept  under  glass  bells  or 
cases,  are  among  the  most  beautiful  that  can  be  made. 

As  corroded  preparations  break  from  the  slightest  vio- 
lence, I have  used  with  great  improvement  to  their  strength, 
a size  of  isinglass,  into  which  they  were  dipped ; by  repeated 
applications  of  this  they  become  well  coated  with  it,  and 
thereby  too  strong  to  be  injured  by  slight  jars. 

WET  PREPARATIONS. 

Minute  injections,  generally,  and  all  morbid  derange- 
ments, are  proper  subjects  for  wet  preparations.  The  na- 
tural structure  of  many  parts  is  also  very  advantageously 
displayed  in  this  way.  The  specimen  previously  to  being  put 
up,  should  be  steeped  in  water  changed  daily,  till  all  the 
blood  is  out. 


INTRODUCTION. 


35 


Spirits  of  wine,  spirits  of  turpentine,  and  a solution  of 
corrosive  sublimate,  are  each  suitable  for  suspending  such 
preparations  in.  The  latter  answers  particularly  well  for 
eyes  and  for  thin  membranous  parts,  as  an  intestine,  &c. 
Two  grains  of  corrosive  sublimate,  with  an  equal  quantity 
of  muriate  of  ammonia,  to  an  ounce  of  water,  make  a so- 
lution sufficiently  antiputrescent  for  an  eye,  and  which  con- 
tracts the  preparation  much  less  than  spirits  of  wine.  When 
larger  bodies  are  preserved,  the  quantity  of  corrosive  subli- 
mate must  be  increased  proportionably. 

Corrosive  sublimate  witlj  in  fact  all  saline  solutions,  has 
however,  the  disadvantage  of  precipitating  after  a while. 

Bottles  for  wet  preparations  should  have  wide  mouths, 
short  necks,  and  broad  heavy  bottoms.  The  preparation 
being  properly  displayed  and  suspended,  the  mouth  of  the 
bottle  must  be  secured  with  a bladder ; over  this  must  be 
placed  sheet  lead,  about  the  thickness  of  a quarter  of  a dol- 
lar, and  trimmed  so  as  to  correspond  in  size  with  the  top  of 
the  bottle ; over  this  lead  another  piece  of  bladder  is  to  be 
stretched  and  secured.  The  outside  bladder,  being  pro- 
perly trimmed,  should  be  varnished  twice  with  copal  var- 
nish coloured  with  lamp-black. 

In  later  years  a plan  which  I have  found  to  answer  better 
than  any  other  for  closing  bottles,  so  as  to  prevent  evapora- 
tion, is  to  have  the  upper  end,  i.  e.,  mouth  and  neck  of  the 
bottle,  in  the  shape  of  two  short  truncated  cones  joined  at 
their  summits.  This  shape  accommodates  well  a cross  bar 
of  white  metal  as  pewter,  to  which  the  preparation  should  be 
suspended  through  holes.  If  spirits  of  wine  be  used,  a 
waxed  muslin  should  be  attached  by  heat  to  the  under  sur- 
face of  the  leaden  cover,  and  while  still  warm  be  fixed  in 
its  place,  and  then  covered  by  two  layers  of  bladder.  If 
the  menstruum  be  spirits  of  turpentine , the  best  cover  is  a 
moist  bladder  coated  with  dissolved  glue,  containing  a 
small  quantity  of  honey,  or  of  some  saccharine  substance  to 
make  it  less  brittle.  Upon  its  drying,  a lead  may  be  se- 
cured over  it  by  another  layer  of  bladder,  coated  in  the  same 
way.  Generally,  in  wet  preparations  it  is  better  to  secure 
two  or  three  turns  of  fine  strong  twine  around  the  neck  of 
the  bottle  over  the  bladders,  as  the  latter  are  apt  to  crack 
and  loosen  themselves. 


36 


INTRODUCTION. 


QUICKSILVER  INJECTIONS. 

These  constitute  a beautiful  and  interesting  department 
in  the  occupations  of  the  practical  anatomist.  The  parts 
most  frequently  subjected  to  this  process  are  the  lymphatics 
and  lacteals.  In  the  extremities  we  introduce  the  pipe  at 
the  point  farthest  from  the  heart,  and  having  injected  one 
trunk,  the  pipe  must  be  withdrawn  and  introduced  into 
another,  and  so  on  till  all  the  trunks  are  filled.  In  inject- 
ing for  the  lacteals  we  must  introduce  the  pipe  into  a lacteal 
trunk  in  the  mesentery  and  inject  backwards;  as  the  lac- 
teals on  the  intestine  itself  are,  for  the  most  part,  too  small 
to  admit  of  its  introduction  into  them. 

The  liver  has  a great  many  lymphatics  in  its  peritoneal 
coat ; they  may  be  injected  from  one  of  the  trunks  on  the 
broad  ligament.  It  is  unnecessary  to  preserve  the  whole 
liver  ; a section  of  it  half  an  inch  thick,  dried  and  hung  in 
spirits  of  turpentine,  answers  very  well. 

The  parotid  gland  injected  with  quicksilver  from  its 
duct,  affords  a fine  preparation.  The  injection  must  be 
made  before  the  gland  is  removed  from  the  body ; the  blood 
should  afterwards  be  soaked  out,  and  the  gland  dried  anu 
hung  in  spirits,  of  turpentine. 

The  Vesiculae  Seminales  and  the  Testicles  of  the  adult, 
are  also  suitable  subjects  for  this  kind  of  preparation.  The 
lactiferous  ducts  of  the  Mamma;  are  very  favourably  displayed 
in  the  same  manner ; they  are  injected  separately  from  the 
nipple.  Bristles  should  be  previously  introduced  into  each 
duct,  and  withdrawn  successively  as  the  injection  advances, 
otherwise  we  may  commit  the  mistake  of  injecting  a duct 
twice.  As  each  duct  is  injected,  it  should  be  secured  with 
a ligature.  A woman  who  has  died  during  lactation  is  the 
best  subject  for  it. 

The  hand  of  a thin,  aged  female  may  be  readily  injected, 
both  arteries  and  veins,  by  a pipe  fixed  into  the  radial  arterv. 
After  it  is  filled  it  should  be  macerated  in  water  frequently 


INTRODUCTION. 


37 


changed  till  all  the  blood  is  removed  and  the  cuticle  comes 
off;  it  should  then  be  dried  and  varnished. 

The  Veins  of  the  kidney  of  a cat,  afford  a beautiful  prepa- 
ration with  quicksilver. 


PREPARING  BONES. 

Bones  are  best  prepared  by  maceration  in  warm  weather; 
and  a dropsical  subject  is  much  better  than  any  other,  from 
the  marrow  being  less  abundant  and  mixed  with  serum. 
The  skeleton  should  be  roughly  cleaned  and  put  into  a 
macerating  vessel,  the  brain  being  removed.  The  water 
should  be  changed  daily  as  long  as  it  is  discoloured  by  the 
blood.  Afterwards  it  should  be  left  till  putrefaction  has 
softened  and  dissolved  all  the  ligaments  and  soft  parts. 
The  skeleton  should  then  be  taken  out  and  washed  well  in 
clean  water  with  a little  ley  added  to  it.  It  is  now  to  be 
dried  and  is  fit  for  use.  If  the  maceration  be  properly 
conducted  no  bleaching  is  necessary ; if  otherwise,  the  pro- 
cess adopted  in  whitening  linen  and  cotton  cloths,  answers 
well,  that  is,  exposure  to  the  sun,  and  frequently  wetting 
with  clean  water  or  with  weak  chlorine  water. 

A cranium  from  four  to  ten  years  old  treated  in  this  way, 
affords  a fine  preparation  for  studying  its  bones  in  a state  of 
separation.  To  accomplish  the  latter,  it  is  only  necessary 
to  fill  its  cavity  with  peas  or  beans  after  the  maceration  is 
over,  and  to  immerse  it  in  warm  water.  The  beans  in  a 
short  time  begin  to  swell  and  open  the  sutures  completely. 
The  bones  of  the  face  must  be  taken  asunder  with  the 
fingers. 

In  order  to  show  the  animal  part  only  of  bone,  take 
a section  of  it  and  immerse  it  in  an  acid  mixture  com- 
posed of  muriatic  acid  one  ounce,  and  water  one  pint.  In 
from  one  to  four  months,  according  to  the  size  and  solidity 
of  the  bone,  the  calcareous  part  will  be  taken  away  by  the 
acid.  The  acid  is  to  be  renewed  from  time  to  time.  On 
such  a preparation  one  may  demonstrate  the  pliability  and 
the  lamellated  and  fibrous  texture  of  the  hardest  bone. 


38 


INTRODUCTION. 


A bone,  by  being  thrown  into  a strong  fire,  will  have  all 
its  animal  parts  destroyed  and  nothing  but  the  calcareous 
left.  This  preparation  is  the  reverse  of  the  last. 

To  demonstrate  the  vascularity  of  bone,  cut  off  the  limb 
of  a foetus*,  or  of  a young  child,  and  fix  a pipe  into  the  prin- 
cipal artery.  By  filling  the  part  with  the  size  injection,  the 
vessels  of  the  bone  will  also  be  injected.  Remove  the  flesh 
when  it  becomes  cold,  and  macerate  in  water  till  the  blood 
is  washed  out.  Place  the  bone  in  the  acid  mixture  just 
mentioned  till  the  calcareous  part  is  removed ; soak  it  in 
pure  water  again  for  a day ; then  dry  it,  and  finally  immerse 
it  in  spirits  of  turpentine  to  make  it  transparent.* 


The  ah’  of  rooms,  where  dead  bodies  are  kept,  as  well  as 
the  walls  and  furniture,  become  exceedingly  offensive ; to 
correct  which  we  resort  to  the  following  mixture  with  great 
advantage.  It  is  called  the  Guytonian  from  its  inventor. 


The  water  and  the  acid  should  be  previously  mixed  and 
allowed  to  cool.  Then  stir  all  the  ingredients  well  together 
in  a stone  vessel. 

When  the  room  is  abandoned  for  the  night,  close  its 
doors  and  windows  and  commence  this  fumigation.  The 
next  morning  it  will  be  found  much  sweetened,  and  on  ven- 
tilating freely,  its  atmosphere  will  lose  still  more  of  its  of- 
fensiveness and  be  in  a great  measure  renovated. 

* For  a very  valuable  and  instructive  exposition  in  detail,  the 
student  is  referred  to  a work  entitled  Directions  for  making  Anatomi- 
cal Preparations;  by  Usher  Parsons,  M.  D.  Professor,  &c.  Phila. 
1831.  Also  Anatomical  Manipulation,  &c.,  by  Tulk  and  Henfrey. 
London,  1844. 


ON  FUMIGATION. 


Take  Oxide  of  Manganese 


1 part  by  weight. 
7 parts 
4 parts 
4 do 


Common  salt 
Water 

Sulphuric  acid  at  66°, 


INTRODUCTION. 


39 


The  fumes  of  this  mixture  are  very  penetrating  ; they  give 
their  peculiar  smell  to  clothing  for  several  days,  and  rust 
metallic  surfaces  intensely.  All  articles  therefore,  which 
are  not  intended  for  such  depuration,  should  be  removed. 

A milder  fumigation  which  may  be  used  beneficially  in 
sick  chambers,  is  obtained  by  pouring  in  successive  portions, 
five  parts  of  hydrochloric  acid  upon  one  of  peroxide  of 
manganese. 

PRECAUTIONARY  MEASURES  AGAINST  DISSECTING 
WOUNDS. 

The  propriety  of  using  certain  precautions  in  performing 
Post  Mortem  examinations,  especially  if  the  patients  have 
died  of  disease  of  the  Serous  Membranes,  or,  of  an  Erysipela- 
tous character,  is  now  well  established.  Under  the  cir- 
cumstances protection  will  ensue  from  smearing  the  hands 
with  oil  or  lard;  and  if  sores,  scratches,  or  abrasions  exist  on 
the  fingers,  even  in  the  slightest  degree,  they  should  be 
covered  with  adhesive  plaster  or  touched  with  Nitrate  of 
Silver,  so  as  to  form  an  eschar.  If  the  operator  should 
wound  himself,  or  the  matter  or  fluids  of  th’e  corpse  come 
in  contact  with  an  abrasion,  he  should  immediately  wash 
his  hands,  and  suck  the  part  thoroughly,  in  order  to  draw 
blood  if  possible;  or  it  may  be  necessary  to  apply  a cup- 
ping glass,  when  practicable. 

Students  of  Anatomy  frequently  have  their  fears  much 
excited  on  the  score  of  the  constitutional  symptoms,  arising 
from  small  wounds  inflicted  during  their  ordinary  dissections; 
under  an  erroneous  impression,  that  a specific  virus  is,  there- 
by, introduced  into  the  system,  as  in  cases  of  the  post  mortem 
examinations  just  referred  to.  Inconveniences  of  this  kind, 
though  they  occasionally  do  occur,  are  by  no  means  frequent; 
and  are  just  as  apt  to  be  produced  from  the  prick  of  a needle, 
of  a brier,  or  of  an  oyster-shell.  The  first  intimation  of  such 
mischief,  is  the  part  becoming  painful,  red,  and  swollen, 
and  the  arm  getting  somewhat  stiff;  if  in  the  early  stage  of 
these  symptoms,  a blister  be  applied  according  to  the  recom- 
mendation of  Dr.  Physick;  the  person  live  lightly,  and  take  a 


40 


INTRODUCTION. 


saline  cathartic,  the  treatment  is  almost  invariably  sufficient 
for  the  cure.  Such  accidents  are  much  more  liable  to  oc- 
cur from  the  prick  of  a spicula  of  bone,  than  from  any  other 
cause  to  which  the  Anatomist  is  exposed,  furnishing  thereby, 
a useful  hint  for  him,  never  to  break  a bone,  but  always  to 
saw  it  off  smoothly. 


PART  I, 


OF  THE  HEAD  AND  NECK, 


CHAPTER  I. 

OF  THE  EXTERNAL  PARTS  OF  THE  HEAD 
AND  NECK. 

The  integuments  of  the  cranium  are  remarkably  thick  and 
hard,  but  give  the  sensation,  when  felt  externally,  of  being 
a very  thin  layer  spread  over  the  bones.  The  latter  is 
particularly  the  case  as  far  as  the  hair  extends.  They  con- 
sist of  skin,  and  below  it  of  small,  compact,  granulated 
masses  of  fat  enclosed  in  the  cells  of  a cellular  substance ; 
which  has  very  much  of  a ligamentous  character,  and  ad- 
heres closely  to  the  muscle  and  tendinous  matter  beneath. 

Beneath  the  cranium  we  find  the  brain,  which  being  liable 
to  rapid  decomposition  should  generally  be  the  first  part  ex- 
amined, before  softening  has  changed  materially  its  structure; 
after  which,  the  muscles  of  the  face  should  be  dissected,  as 
under  the  most  favourable  circumstances  they  are  difficult  for 
the  student  to  make  out,  and  are  rendered  unintelligible  to 
him  in  a few  days  by  the  changes  which  their  diminution  of 
volume,  infiltration,  and  confusion  of  colour  with  contiguous 
parts,  produce. 

I would  also  advise  that  one  side  of  the  face  and  neck  be 
appropriated  exclusively  to  the  dissection  of  the  fasciae, 


42 


OF  THE  ENCEPHALON  OK  BRAIN. 


muscles,  and  glands ; every  thing,  therefore,  should  be  re- 
moved which  interferes  with  a thorough  examination  of  them. 
The  student  having  accomplished  this,  may  afterwards  work 
on  the  other  side  of  the  subject  for  the  blood-vessels  and 
nerves.  To  trace  the  arteries  properly,  they  ought  to  be 
filled  previously  with  coarse  injection ; it  is  of  less  impor- 
tance to  inject  the  veins. 


SECTION  I. 

OF  THE  ENCEPHALON  OR  BRAIN. 

The  best  way  to  get  at  the  brain,  both  in  public  and  private 
dissection,  is  to  make  a cut  through  the  scalp  across  the  top 
of  the  head  from  ear  to  ear,  then  to  turn  down  the  scalp  and 
tendon  of  the  occipito  frontalis  muscle  over  the  face,  and  be- 
hind the  back  of  the  neck.  The  skull-cap  may  be  separated 
by  a saw  carried  only  through  the  external  table  just  above  the 
tips  of  the  ears,  and  about  an  inch  above  the  superciliary 
ridges.  With  the  aid  of  an  iron  chisel,  and  a mallet,  the 
bone  is  afterwards  easily  broken  through  and  separated  from 
the  dura  mater.  Should  the  adhesion  of  the  latter  be  great 
a common  spatula  is  very  well  adapted  to  destroy  it.  Bichat 
broke  the  skull-cap  to  pieces  with  a hammer  and  then  re- 
moved it, 'which  is  a much  inferior  mode  to  the  other,  and 
objectionable  from  the  spiculse  of  bone  made  by  it. 

The  vault  of  the  cranium  being  removed  as  directed,  an 
inspection  of  its  internal  table,  shows  us  the  grooved  chan- 
nels made  by  the  Arteria  Meningea  Media  over  nearly  its 
whole  surface — the  groove  for  the  Superior  Longitudinal 
Sinus,  on  its  middle  line,  and  a number  of  ulcerated  look- 
ing fossae  made  by  the  Glands  of  Pacchioni. 

The  medullary  mass  placed  within  the  cavity  of  the  cra- 
nium is  termed  in  common  language  Brain,  It  affords  the 
following  parts  for  separate  examination.  1.  The  Mem- 
branes. 2.  The  Cerebrum.  3.  The  Cerebellum.  4.  The 
Pons  Varolii  and  the  Medulla  Oblongata. 


THE  DURA  MATER. 


43 


1.  The  Membranes  are  three:  The  Dura  Mater,  Tunica 
Arachnoidea,  and  Pia  Mater. 

The  Dura  Mater  lies  immediately  in  contact  with  the 
bones  of  the  cavity  of  the  cranium,  being  closely  connected 
to  them  at  every  point  by  filaments  of  fibres,  and  by  very 
numerous  small  blood-vessels,  which  are  shown  by  the  dots 
of  blood  upon  it,  when  the  bones  are  removed  as  in  this 
manner  of  opening  the  head.  It  is  a white,  shining,  fibrous, 
semitransparent  membrane  consisting  of  two  layers  closely 
adherent  to  each  other,  the  internal  of  which  forms  several 
processes.  The  most  conspicuous  is  the  Falx  Major,  or 
Cerebri,  which  arises  from  the  middle  of  the  body  of  the 
sphenoid  bone,  from  the  crista  galli  of  the  ethmoid,  from 
under  the  whole  of  the  middle  line  of  the  frontal  bone,  the 
sagittal  suture,  and  superior  part  of  the  occipital  bone,  as  far 
as  the  junction  of  the  limbs  of  its  cross  at  the  internal  occi- 
pital protuberance.  It  is  narrow  before  and  broader  behind, 
where  it  joins  with  the  tentorium. 

Being  strongly  fastened  in  front  and  behind,  it  is  kept  in 
a state  of  strict  tension,  which  prevents  any  lateral  deviation. 
Its  inferior  edge  is  concave,  and  reaches  nearly  to  the  Cor- 
pus Callosum. 

The  next  process  is  the  Tentorium,  which  forms  an  arch 
slightly  convex  above,  and  crescentic  in  its  general  figure. 
It  is  connected  to  the  Falx  Major,  to  the  horizontal  limbs 
of  the  occipital  cross,  to  the  superior  ridge  of  the  petrous 
bones,  and  to  the  posterior  clinoid  apophysis  on  each  side. 
On  each  side  of  the  sella  turcica,  is  a process  of  dura  mater 
forming  its  lateral  boundaries.  At  the  anterior  edge  of  the 
tentorium  is  the  Foramen  Ovale,  which  is  occupied  by  the 
Pons  Varolii  and  Crura  Cerebri,  and  immediately  under  the 
centre  of  the  tentorium  and  running  towards  the  occipital 
foramen,  is  the  Falx  Minor  or  Cerebelli. 


SINUSES  OF  THE  DURA  MATER. 

The  Sinuses  are  large  cavities  placed  between  the  two 
lamime  of  the  Dura  Mater,  and  receive  the  blood  from  the 
veins  of  the  Pia  Mater.  They  are  formed  by  the  separation 
of  these  laminse,  and  are  lined  by  a membrane,  correspond- 
ing with  the  internal  coat  of  the  veins. 


44 


OF  THE  ENCEPHALON  OR  BRAIN. 


The  first  is  the  Superior  Longitudinal  Sinus,  and  is  trian- 
gular ; it  commences  by  a small  beginning  near  the  crista 
galli,  having  according  to  some,  a small  vein  from  the  nose 
joining  it  through  the.  foramen  caecum.  It  enlarges  by  a 
continual  accession  of  veins  from  the  pia  mater  and  termi- 
nates at  the  occipital  cross.  On  cutting  into  it,  we  see  it 
lined  by  a delicate  smooth  membrane ; — its  sides  retained 
together  by  many  little  tendinous  strings  called  the  Chordae 
Willisii  or  Trabeculae ; — and  the  veins  of  the  pia  mater  run- 
ning into  it  obliquely  forwards,  and  furnished  with  valves. 
In  this  sinus,  and  also  under  the  dura  mater  near  the  top  of 
the  brain,  are  many  small  bodies  of  various  sizes,  the  Glan- 
dulae  Pacchioni,  from  a line  or  less  to  three  or  four  lines  in 
diameter.  One  of  the  largest  of  these  bodies  on  each  side, 
near  the  parietal  foramen,  actually  protrudes  from  the  sur- 
face of  the  brain  through  the  dura  mater,  and  makes  a deep 
pit  into  the  parietal  bone,  near  the  sagittal  suture.  They 
have  no  excretory  ducts  that  have  been  discovered,  and  it 
is  uncertain  whether  any  specific  fluid  is  secreted  by  them. 

A View  of  the  Dura  Mater  of  the  Cranium  and  part  of  the  Spinal 
Canal;  with  their  Sinuses. 

I. 2.3.  A Section  of  the  Bones 
composing  the  Vault  of  the 
Cranium,  showing  the 
arched  attachment  of  the 
Falx  Major. 

4.  Anterior  portion  of  the 
Superior  Longitudinal  Si- 
nus. 

5.  Its  Middle  Portion. 

6.  Its  Inferior  Portion ; the 
outer  table  of  the  Cranium 
is  removed. 

7.  Commencement  of  the  In- 
ferior Longitudinal  Sinus. 

8.  Its  Termination  in  the 
Straight  Sinus. 

9.  The  Sinus  Quartus  or 
Rectus. 

10.  The  Vence  Galeni. 

II.  One  of  the  Lateral  Sinuses. 

12.  The  Torcular  Herophili. 

13.  The  Sinus  of  the  Falx  Ce- 
rebelli. 

14.  The  Internal  Jugular  Vein. 

15.  The  Dura  Mater  of  the 
Spinal  Marrow. 

16.  The  Tentorium  Cerebelli 

17.  17.  The  Falx  Cerebri. 


Fig.  1. 


OF  THE  ENCEPHALON  OR  BRAIN. 


45 


From  the  posterior  extremity  of  the  longitudinal  sinus 
proceeds  on  each  side  in  the  posterior  margin  of  the  tento- 
rium, the  Lateral  Sinus,  to  terminate  in  the  foramen  lacerum 
posterius.  The  lateral  and  inferior  veins  of  the  cerebrum 
and  the  inferior  veins  of  the  cerebellum,  run  into  the  Lateral 
Sinus. 

At  the  inferior  edge  of  the  falx  major  just  above  its  con- 
cave edge  and  between  its  duplication,  is  the  Inferior  Longi- 
tudinal Sinus.  And  at  the  junction  of  the  falx  major  and 
tentorium,  is  the  Sinus  Quartus  or  Rectus,  formed  by  the 
Inferior  Longitudinal  Sinus  and  a vessel  from  the  interior  of 
the  brain  called  the  Vena  Galeni.  The  sinus  quartus  joins 
the  superior  longitudinal  sinus  at  the  internal  occipital  pro- 
tuberance where  the  general  meeting  of  the  vessels  is  called 
Torcular  Herophili. 


1.  The  Ophthalmic  Veins.  2.  The  Cavernous  Sinus  of  one  side.  3.  The 
Circular  Sinus;  the  figure  occupies  the  position  of  the  Pituitary  gland  in 
the  Sella  Turcica.  4.  The  Inferior  Petrous  Sinus.  5.  The  Transverse  or 
anterior  occipital  sinus.  G.  The  Superior  Petrous  Sinus.  7.  The  Internal 
Jugular  Vein.  8.  The  Foramen  Magnum.  9.  The  posterior  Occipital  Si- 
nuses. 10.  The  Torcular  Herophili.  1 1,  1 1 . The  Lateral  Sinuses. 


The  sinuses  of  the  base  of  the  skull.' 

Fig.  2. 


46 


OF  THE  ENCEPHALON  OR  BRAIN. 


Around  the  pituitary  gland,  in  the  sella  turcica,  is  the 
Circular  Sinus  of  Ridley;  and  on  each  side  of  the  sella 
turcica,  is  the  Cavernous  Sinus.  On  the  occiput  and  about 
the  petrous  bone  there  are  several  smaller  sinuses  which, 
together  with  the  circular  and  cavernous,  empty  into  the 
lateral. 

The  Dura  Mater  is  supplied  with  nerves  from  the  sympa- 
thetic which  are  traced  with  some  difficulty.  Its  principal 
artery  is  from  the  internal  maxillary,  and  passes  through  the 
foramen  spinale,  making  the- deep  arborescent  indentations 
in  the  parietal  bones.  There  are  some  other  branches  de- 
rived from  the  internal  carotids  and  vertebrals.  Some  of 
the  veins  accompany  the  arteries,  and  discharge  into  the 
sinuses  about  the  base  of  the  cranium. 


Within  the  dura  mater  and  covering  the  whole  exterior 
surface  of  the  pia  mater,  is  the  Tunica  Arachnoidea,  a deli- 
cate transparent  membrane  with  no  red  vessels  in  its  com- 
position. It  forms  an  uniform  coat,  not  dipping  into  the 
convolutions  of  the  encephalon,  and  may  be  seen  dis- 
tinctly on  the  superior  surface  of  the  brain  like  a shining, 
smooth  surface  to  the  pia  mater,  but  cannot  readily  be  raised 
up  from  it.  On  the  base  of  the  brain,  it  is  continuous  with 
the  tunica  arachnoidea  of  the  medulla  spinalis.  It  lines 
the  internal  surface  of  the  dura  mater  in  an  analogous  man- 
ner to  that  of  the  synovial  membranes  of  the  joints  with 
the  capsular  ligaments,  and  secretes  a lubricating  fluid  which 
facilitates  the  motions  of  the  brain. 

The  Pia  Mater  is  a tender  and  highly  vascular  mem- 
brane, lying  in  close  contact  with  the  brain,  dipping  into  its 
convolutions  and  spread  over  the  surface  of  its  ventricles  in 
a manner  difficult  to  be  understood  without  dissection.  It 
is  much  thinner  and  more  delicate  in  tire  cavities  of  the 
brain  than  exteriorly,  and  seems  there  more  like  a vascular 
net-work  than  a perfect  membrane.  By  its  course  between 
the  fornix  and  thalami  it  constitutes  the  Velum  Interpositum 
or  Tela  Choroidea.  It  is  highly  useful  in  conducting  vessels 
into  the  substance  of  the  brain  by  being  so  extensively 
spread  over  its  surface,  and  by  dividing  them  minutely 
before  they  penetrate  it. 

Its  blood-vessels  are  exceedingly  numerous,  being  re- 


OF  THE  CEREBRUM. 


47 


ceived  from  the  vertebral  and  internal  carotid  arteries  at  the 
basis  of  the  cranium  in  the  manner  which  will  be  explained 
at  the  end  of  the  chapter.  Its  veins  are  all  introduced  into  the 
sinuses  of  the  dura  mater,  and  therefore  do  not  accompany 
the  arteries. 

THE  CEREBRUM. 

2.  The  Cerebrum  weighs  about  three  pounds,  and  is  se- 
ven times  as  heavy  as  the  cerebellum.  It  fills  by  far  the  great- 
er part  of  the  cavity  of  the  cranium,  and  extends  from  the 
tentorium  and  anterior  basis  of  the  cranium,  to  the  vault  of 
the  latter.  Above,  it  is  partially  divided  by  the  falx  major,  into 
two  equal  parts  called  Hemispheres,  and  below,  we  see  that 
each  of  these  hemispheres  is  subdivided  into  three  lobes. 
The  Anterior  Lobe  is  placed  upon  the  orbitar  process  of  the 
frontal  bone ; the  Middle  Lobe  is  in  the  middle  fossa  of  the 
base  of  the  cranium ; and  the  Posterior  Lobe  upon  the  ten- 
torium. Between  the  anterior  and  middle  lobes  there  is  a 
deep  indentation,  the  Sulcus,  or  Fissura  Magna  Sylvii,  cor- 
responding in  position  with  the  posterior  edge  of  the  little 
wing  of  the  sphenoid  bone,  which  prescribes  their  bounda- 
ries. The  middle  and  posterior  lobes  are  not  so  well  sepa- 
rated from  each  other. 

The  external  surface  of  the  cerebrum,  is  arranged  into 
many  convolutions  ( Gyri)  which  at  a little  distance,  give  it 
the  appearance  of  the  intestines  of  a child.  The  pia  mater, 
dipping  down  to  the  bottom  of  the  Sulci  between  them, 
keeps  their  opposite  faces  in  contact. 

If  a section  be  made  into  the  brain,  it  will  be  seen  to 
consist  of  matter  of  different  colours  and  consistence.  The 
external  matter,  varies  from  a line  to  three  or  four  in  depth ; 
is  called  the  Cineritious  or  Cortical ; is  of  a yellowish  red 
colour^  somewhat  less  consistent  than  the  other;  and  covers 
all  the  convolutions.  Within  the  cortical  is  the  Medullary 
or  Fibrous  Matter,  which  is  of  a white  colour,  with  small 
spots  or  dots  of  red  owing  to  the  blood-vessels. 

By  separating  the  hemispheres,  we  see  that  just  below  the 
edge  of  the  falx  major  they  adhere  together  by  the  pia  ma- 
ter of  the  opposite  sides.  Dissect  this  adhesion  through, 
and  a broad  expansion  of  medullary  matter,  the  Corpus  Cal- 
losum, is  seen  extending  from  tire  anterior  to  the  posterior 
edge  of  the  falx,  and  marked  in  its  centre  by  two  white  lines 


48 


OF  THE  CEREBRUM. 


running  longitudinally  and  slightly  curved,  with  their  con- 
vexities towards  each  other.  Between  these  lines  is  a fossa 
called  Raphe.  Other  lines  not  so  distinct  pass  laterally  and 
at  right  angles  to  the  first  two.  By  pulling  the  hemisphere 
still  more  from  its  fellow,  we  bring  into  view  its  edge,  which 
laps  over  the  corpus  callosum  and  is  separated  from  it  by 
a fissure  running  the  whole  length  of  the  latter. 

The  Encephalon  being  looked  upon  by  the  best  authori- 
ties of  the  present  day  as  a development  of  the  spinal  mar- 
row, may  now  be  taken  out  of  the  head  and  studied  from 
below  upwards,  instead  of  from  above  downwards.  This 
method  has  the  advantage  of  fixing  on  the  mind  the  order 
of  growth,  but  as  it  is  difficult  to  demonstrate  the  parts  in 
the  recent  state  according  to  this  plan,  the  following  outline 
will  perhaps  sufficiently  explain  the  order  of  appearances, 
"whilst  the  continuance  of  tire  brain  in  the  cranium  will  faci- 
litate its  dissection. 

In  proceeding  with  the  anatomy  of  the  brain  from  its  base 
upwards,  the  following  is  the  order  of  succession  of  parts  in 
its  structure.  The  Medulla  Oblongata,  the  continuation  of 
the  Medulla  Spinalis — -the  Pons  Varolii  on  the  top  of  the  me- 
dulla oblongata;  the  Crura  Cerebelli  running  off  on  each 
side  to  form  the  Cerebellum,  and  the  two  diverging  trunks 
Crura  Cerebri,  in  advance  of  the  Pons,  which  run  forwards 
and  are  lost  in  the  medullary  substance  of  the  Cerebrum. 
On  the  upper  surface  of  these  are  two  protuberances;  the 
posterior  is  the  Thalamus  Nervi  Optici,  and  the  anterior 
the  Corpus,  Striatum.  Each  crus  cerebri  having  penetrated 
into  the  substance  of  its  respective  hemisphere,  expands  by 
a multiplication  of  the  fdaments  composing  it,  so  as  to  con- 
stitute the  principal  bulk  of  the  hemisphere.  The  filaments 
may  be  satisfactorily  traced  in  almost  every  direction  to- 
wards the  periphery  of  the  cerebrum,  where  they  terminate 
in  the  convolutions,  their  extremities  being  covered  by  the 
cineritious  matter  there.  The  arrangement  is  best  seen  by 
scraping  with  a knife  along  the  base  of  the  brain,  especially 
when  the  latter  has  been  hardened  in  spirits  of  wine,  and  it 
is  constituted  by  what  are  called  the  diverging  fibres  of  the 
brain  by  Gall  and  Spurzheim.  The  point  is  not  indeed  en- 
tirely settled  that  the  diverging  fibres  end  in  the  convolutions, 
or  rather  do  not  afterwards  inflect  or  double  themselves,  and 
pass  onwards  again  to  the  middle  line  of  the  brain,  forming 
by  their  convergence  the  Corpus  Callosum.  At  ail  events, 


OF  THE  CEREBRUM. 


49 


the  fact  is  quite  demonstrable  that  as  the  lateral  and  under 
portions  of  the  hemispheres  consist  in  diverging  fibres 
arising  in  and  from  the  crus  cerebri,  so  the  upper  portion 
and  the  corpus  callosum  consists  in  filaments  which  arise  in 
the  adjoining  convolutions  and  collect  towards  the  middle 
line  of  the  corpus  callosum,  where  they  adhere  to  their 
congeners  of  the  opposite  side.  The  simplest  illustration 
of  this  arrangement  is  given  by  folding  a towel  or  strip  of 
cloth  double,  on  itself  so  as  to  convert  it  into  a loop ; the 
under  part  of  the  loop  would  be  the  diverging  fibres  of  the 
cerebrum,  and  the  upper  part  the  converging  fibres  of  the 
corpus  callosum,  it  being  recollected  that  the  continuation 
of  the  two  orders  of  fibres  into  one  another  in  the  brain  is 
not  so  fully  ascertained  as  is  represented  in  this  model. 
Between  the  two  orders  of  fibres  there  is  a horizontal  cleft 
or  interval.  This  interval  is  the  lateral  ventricle,  which 
may  be  got  into,  under  the  posterior  margin  of  the  corpus 
callosum,  from  its  being  open  there,  or  rather  only  closed 
by  an  adhesion  of  the  membranes,  which  is  easily  lacerated. 

A DIAGRAM,  REPRESENTING  A TRANSVERSE  SECTION  OF  THE  BRAIN. 

Fig.  3. 

a 


1.  1.  The  Corpus  Callosum,  or  great  commissure  of  the  hemispheres, 
extending  transversely  into  each  hemisphere.  2.  The  Raphe  a linear  de- 
pression between  two  slightly  elevated  ridges.  3.  3.  The  Lateral  Ventri- 
cles. 4.  The  space  between  the  two  layers  of  the  septum  lucidum  called 
the  Fifth  Ventricle.  5.5.  The  Fornix.  6.  6.  The  thin  edges  of  the  fornix, 
called  Corpora  Fimbriata.  7.  The  Velum  Interpositum.  8.8.  The  plexi- 
form  borders  of  the  velum  interpositum,  called  Plexus  Choroides.  9.  9. 
The  Thalami  Optici.  10.  The  space  between  the  two  thalami,  called  Third- 
Ventricle.  11.  The  gray  commissure  of  the  thalami  optici,  called  middle 
commissure,  or  commissura  mollis  of  the  third  ventricle.  12.  The  line 
of  the  base  of  the  brain. 

The  details  of  the  brain  may  now  be  learned  by  removing 
the  hemispheres  above  the  corpus  callosum,  with  a sharp 
4 


50 


OF  THE  CEREBRUM. 


knife,  whereby  a view  is  got  of  the  Centrum  Ovale  of  Vieus- 
sens,  and  also  of  the  connexion  formed  between  the  hemi- 
spheres by  the  corpus  callosum.  The  Centrum  Ovale  is, 
properly  speaking,  the  oval  nucleus  of  medullary  matter 
which  is  left  when  the  cortical  is  scraped  or  cut  away,  but  is 
most  commonly  described  as  the  oval  disk  which  is  formed 
by  the  aforesaid  section.  The  corpus  callosum  is  placed 
in  its  middle,  and  forms  the  great  medullary  commissure 
between  its  two  sides,  and  also  the  roof  of  the  lateral 
ventricles. 

By  removing  the  corpus  callosum,  the  Lateral  Ventricles, 
one  on  each  side  are  brought  into  view.  They  are  horizontal 
cavities  or  fissures  of  an  extremely  irregular  shape,  in  the 
very  centre  of  the  hemispheres;  being  the  interval  between 
the  diverging  and  converging  filaments  of  the  cerebrum,  and 
consist  each  of  a central  portion  or  body,  and  three  processes 
or  cornua,  which  extend  from  the-  anterior  to  the  posterior 
portions  of  the  hemispheres.  In  the  anterior  lobe  is  the 
Anterior  Cornu  separated  only  by  the  Septum  Lucidum 
from  its  fellow.  In  the  middle  lobe  is  the  Inferior  or  Mid- 
dle Cornu  passing  in  a winding  direction  downwards  and 
forwards,  and  in  the  posterior  lobe  is  the  Posterior  Cornu, 
also  called  Digital  Cavity. 

The  Lateral  Ventricles  of  the  Cerebrum. 

FlG.  4.  1.1.  The  two  Hemispheres  cut 

down  to  a level  with  the 
Corpus  Callosum,  so  as  to 
show  the  Centrum  Ovale 
Majus.  The  surface  is  stud- 
ded with  the  small  Puncta 
Vasculosa. 

2.  A small  portion  of  the  An- 
terior Extremity  of  the  Cor- 
pus Callosum. 

3.  Its  Posterior  Boundary;  the 
intermediate  portion,  form- 
ing the  Roof  of  the  Lateral 
Ventricles,  has  been  removed 
so  as  to  completely  expose 
these  cavities. 

4.  A part  of  the  Septum  Luci- 
dum, showing  a space  be- 
tween its  layers  which  is 
the  5lh  Ventricle. 

5.  The  Anterior  Cornu  of  one 
side. 

(L.  The  commencement  of  the 
Middle  Cornu. 


OF  THE  CEREBRUM. 


51 


7.  The  Posterior  Cornu. 

8.  The  Corpus  Striatum  of  one  Ventricle. 

9.  The  Tcenia  Striata. 

10.  A small  part  of  the  Thalamus  Opticus. 

11.  The  Plexus  Choroides. 

12.  The  Fornix. 

13.  The  commencement  of  the  Hippocampus  Major  in  the  Middle  Cor- 
nu. The  Rounded  Oblong  Body  in  the  Posterior  Cornu  of  the  Lateral  Ven- 
tricle, directly  behind  the  Figure  13,  is  the  Hippocampus  Minor.  A bristle 
is  seen  in  the  Foramen  of  Monro. 


In  the  anterior  part  of  the  lateral  ventricle  is  the  Corpus 
Striatum,  a long  convex  body,  broad  before  and  coming  to 
a point  behind;  it  is  cineritious  or  cortical  externally  and 
medullary  within;  when  scraped  the  latter  looks  fibrous. 
At  the  posterior  part  of  the  corpus  striatum  is  the  Thalamus 
Nervi  Optici,  a large  convex  body,  the  surface  of  which  is 
medullary,  and  the  interior  cortical;  it  has  anode  or  tubercle 
(Tuberculum  Anterius,)  on  its  upper  anterior  face,  and  three 
on  its  posterior  side  ; they  are  of  different  sizes  in  different 
subjects,  and  called  Tuberculum  Posterius  Superius,  Corpus 
Geniculatum  Internum,  and  Corpus  Geniculatum  Externum. 
Between  the  thalamus  and  the  corpus  striatum  in  the  angle 
formed  between  the  internal  margin  of  the  corpus  striatum, 
and  the  external  one  of  the  thalamus  opticus  is  a streak  of 
medullary  matter  called  Taenia  Striata. 

In  the  posterior  cornu  of  the  lateral  ventricle  is  a rising, 
called  Hippocampus  Minor,  or  Ergot  from  its  resemblance 
to  a cock’s  spur ; and  in  the  inferior  cornu  is  a larger  rising 
the  Hippocampus  Major  or  Cornu  Ammonis,  passing  to  its 
bottom  and  increasing  in  breadth  as  it  descends.  Its  lower 
end  terminates  by  two  or  three  tubercles  which  give  it  the 
appearance  of  a claw,  being  called,  from  that  cause,  Pes 
Hippocampi. 

A considerable  part  of  the  Thalami  Nervorum  Opticorum 
is  concealed  by  the  Fornix.  This  is  a triangular  arched 
body  of  medullary  matter,  narrow  before  and  broad  be- 
hind, and  extending  from  the  anterior  to  the  posterior  ex- 
tremity of  the  thalami.  It  commences  forwards  by  two  crura 
( Crura  Fornicis  Anteriora,)  very  much  curved,  with  their  con- 
cavity backwards,  and  which  arise  deeply  from  the  sides  of 
the  thalami,  near  their  union  with  the  corpora  striata.  These 
crura  come  afterwards  into  contact,  increase  much  in  breadth, 
conceal  the  thalami,  and  form  the-  fornix,  which  posteriorly 


52 


OF  THE  CEREBRUM. 


is  lost  in  the  back  of  the  corpus  callosum  and  the  hippo- 
campi majores.  The  angle  formed  by  the  Tack  and  lateral 
margins  is  elongated  and  accompanies  the  hippocampus 
major  for  some  distance,  in  the  form  of  a thin  crus  which  is 
easily  demonstrated  by  raising  it  on  the  knife  handle.  This 
crus  is  the  Corpus  Fimbriatum  of  the  Lateral  Ventricle,  or 
Ttenia  Hippocampi.  The  under  surface  of  the  fornix  is  ge- 
nerally called  Lyra  on  account  of  the  striated  under  surface, 
though  this  is  erroneous. 

The  Septum  Lueidum  is  a partition,  fixed  between  the 
lateral  ventricles  at  their  fore  part,  and  extends  from  the  cor- 
pus callosum  above,  to  the  fornix  below.  It  is  of  an  irre- 
gular triangular  shape,  formed  of  two  laminae,  placed  side  by 
side  with  a cavity  between  them  at  their  front,  called  the 
fifth  ventricle.  To  get  a good  view  of  the  septum  lueidum, 
it  should  be  examined  as  the  corpus  callosum  is  raised  up. 
In  many  subjects,  particularly  when  there  has  been  a small 
dropsical  effusion  into  the  ventricles,  the  septum  looks  like 
a continuation  of  the  middle  of  the  fornix,  a lamina  of  it 
being  contributed  by  the  internal  margin  of  each  crus. 

Under  the  fornix  and  lining  the  cavities  of  the  lateral  ven- 
tricles, as  well  as  the  other  ventricles,  is  placed  a delicate 
reflection  of  pia  mater  with  many  vessels  in  it,  but  so  very 
thin  that  it  can  scarcely  be  raised  up  as  a perfect  membrane. 
This  membrane  gets  into  the  lateral  ventricles  from  the  fossa 
of  Sylvius  and  under  the  back  of  the  corpus  callosum. 
Along  the  hippocampus  major  and  the  exterior  margin  of 
the  fornix,  on  each  side,  is  placed  a fold  of  it  quite  loose 
and  floating,  which  consists  of  a great  congeries  of  small  veins 
and  arteries.  This  fold  is  the  Plexus  Choroides,  which  be- 
coming smaller  anteriorly,  dips  under  the  anterior  crus  of 
the  fornix,  and  its  veins  unite  into  a large  trunk  which  runs 
under  the  fornix  to  terminate  posteriorly  in  the  Vena  Galeni. 
That  portion  of  the  pia  mater  lying  under  the  fornix  and 
bounded  on  each  side  by  the  plexus  choroides,  being  a more 
complete  membrane,  is  called  the  Velum  Interpositum,  or 
Tela  Choroidea. 

The  fornix  should  now  be  raised  with  the  velum  inter- 
positum, by  cutting  through  its  anterior  crura  and  turning  it 
backwards,  which  gives  a more  perfect  view  of  the  thalami. 
From  these  bodies  on  the  opp'osite  sides  being  in  contact,  a 
kind  of  junction,  the  Commissura  Mollis,  is  formed  by  their 
convexities.  Anterior  to  this  junction,  is  a triangular  space 


OF  THE  CEREBRUM. 


53 


called  Vulva.  It  is  here  that  the  lateral  ventricles  commu- 
nicate, under  the  anterior  crura  of  the  fornix,  with  the  third 
ventricle.  This  communication  is  the  Foramen  of  Monro. 
Behind  the  commissura  mollis  is  a similar  triangular  space, 
the  Anus.  The  Third  Ventricle  is  now  brought  fully  into 
view  by  separating  the  thalami,  and  we  shall  find  that  it  is 
a narrow  oblong  cavity  bounded  below  by  the  pons  tarini 

A View  of  the  Ventricles  of  the  Brain,  as  given  by  a Transverse 
Section  of  the  Cerebrum  just  above  the  top  of  the  Lateral  Ventri- 
cles and  a Perpendicular  Section  of  the  Cerebellum. 

1.  Section  of  the  Os  Frontis. 

2.  Its  Orbitar  Plate. 

3.  Anterior  Lobes  of  the  Ce- 
rebrum. 

4.  Its  Posterior  Lobes. 

5.  The  Medullar}'  or  White 
Mutter  of  the  Cerebrum. 

6.  The  Cineritious  or  Gray 
Matter. 

7.  Anterior  portion  of  the 
Middle  Fissure  of  the  Ce- 
rebrum. 

8.  Section  of  the  Anterior 
portion  of  the  Corpus  Cal- 
losum. 

9.  The  curved  portion  of  the 
anterior  part  of  the  Cor- 
pus Callosum  placed  be- 
tween the  Corpora  Striata. 

10.  Anterior  portion  of  the 
Corpora  Striata. 

11.  Their  Posterior  Extremi- 
ty- 

12.  The  Thalami  Nervi  Op- 
tici. 

13.  The  Tienia  Striata. 

14.  Section  of  the  Anterior  Crura  of  the  Fornix. 

15.  Anterior  Extremity  of  the  3d  Ventricle. 

16.  Its  Posterior  Extremity. 

17.  The  Commissura  Mollis. 

18.  The  Peduncles  of  the  Pineal  Gland. 

19.  The  Pineal  Gland. 

20.  The  Tubercula  Quadrigemina. 

21.  The  Valve  ofVieussens  divided  and  turned  on  each  side. 

22.  Section  of  the  Cerebellum  and  Arbor  Vitfe. 

23.  The  4th  Ventricle. — The  dark  middle  Fissure  which  leads  from  the 
Fourth  to  the  Third  Ventricle  under  the  Valve  of  Vieussens  is  the 
Aqueduct  of  Sylvius. 

24.  Lower  portion  of  the  Calamus  Scriptorius. 

25.  Extremity  of  the  Medulla  Spinalis. 


Fig.  5. 


54 


OF  THE  CEREBRUM. 


crura  cerebri  and  emminentia  mammillares,  and  above  by  the 
velum  interpositum  and  fornix.  At  its  lower  front  part  be- 
low the  anterior  commissure  is  an  open  way,  the  Iter  ad 
Infundibulum,  leading  to  the  basis  of  the  brain,  and  at  its 
posterior  part  just  below  the  posterior  commissure,  is  the 
aqueduct  of  Sylvius,  or  the  Iter  e Tertio  ad  Quartum  Yen- 
triculum. 

The  Tubercula  Quadrigemina,  or  Nates  and  Testes,  are 
situated  on  the  superior  face  of  the  Crura  Cerebri  just  behind 
the  thalami,  the  nates  being  above.  They  are  each  about 
three  or  four  lines  in  diameter ; consist  of  medullary  matter 
externally  and  cineritious  within ; and  constitute  a means  of 
communication  between  the  cerebrum  and  cerebellum  by 
being  united  to  the  valve  of  the  cerebellum,  also  called  the 
Valve  of  Vieussens,  which  is  inserted  into  the  lower  part  of 
the  Testes. 

The  Pineal  Gland  is  a small  conoidal  cineritious  body,  of 
a reddish  colour  found  on  the  top  of  the  nates.  It  is  com- 
monly four  lines  in  its  longest  diameter,  and  contains  a 
small  quantity  of  calcareous  matter,  feeling  and  looking  like 
fine  sand,  which,  however,  is  occasionally  collected  into  one 
or  more  irregular  masses  of  a line  in  diameter.  This  sandy 
matter  is  the  Acervulus  Cerebri,  that  appears  about  the  sixth 
year  of  life  and  continues  for  ever  afterwards.  The  pineal 
gland  is  situated  between  the  nates  and  the  back  of  the  fornix, 
being  closely  connected  with  the  under  surface  of,  and  sur- 
rounded by,  the  velum  interpositum,  so  that,  most  frequently, 
when  this  membrane  is  raised  along  with  the  fornix,  the 
pineal  gland  is  torn  from  its  place.  If  we  are  careful  to 
avoid  this  accident,  we  shall  find,  passing  along  the  upper 
internal  face  of  the  thalami,  on  each  side,  above  the  com- 
missura  mollis,  a medullary  streak  the  Peduncle  of  the  pineal 
gland,  which  goes  from  the  latter  to  the  anterior  crus  of  the 
fornix. 

At  the  anterior  part  of  the  third  ventricle,  just  below  the 
crura  fornicis,  and  seen  between  their  curvature  where  they 
diverge,  is  the  Commissura  Anterior,  a medullary  band  like 
a nerve,  near  the  corpus  striatum  and  passing  from  the  lower 
anterior  part  of  one  thalamus,  to  the  other.  At  the  back 
part  of  the  third  ventricle  just  under  the  pineal  gland,  is  the 
Commissura  Posterior  passing  also  from  one  thalamus  to  the 
other,  and  being  a semicylindrieal  fold  of  medullary  matter. 


OF  THE  CEREBELLUM. 


55 


The  Valve  of  Vieussens,  is  seen  by  cutting  off  the  poste- 
rior lobes  of  the  cerebrum,  removing  the  tentorium,  and 
dissecting  away  the  pia  mater  just  behind  and  below  the 
tubercula  quadrigemina.  It  passes  up  as  a broad  lamina  of 
medullary  matter  an  inch  wide,  from  the  central  part  of  the 
cerebellum  to  the  inferior  portion  of  the  testes.  By  intro- 
ducing a probe  from  the  third  ventricle  through  the  aqueduct 
of  Sylvius,  it  will  be  seen  that  this  valve  forms  the  roof  of 
the  fourth  ventricle ; and  that  it  is  thinner  in  its  middle  than 
on  either  side. 

The  farther  examination  of  the  Encephalon  should  be 
prosecuted  by  detaching  it  from  the  basis  of  the  cranium  and 
turning  it  out,  the  nerves  being  left  as  long  as  possible,  and 
the  spinal  marrow  also.  When  inverted,  it  has  the  following 
parts  uppermost.  The  anterior  and  the  middle  lobes,  of  the 
Cerebrum;  the  two  hemispheres  or  lobes  of  the  Cerebel- 
lum; the  pons  Varolii  or  Tuber  Annulare;  and  the  Me- 
dulla Oblongata. 

THE  CEREBELLUM. 

3.  The  Cerebellum  is  remarkable  for  the  difference  be- 
tween its  size  and  that  of  the  Cerebrum,  as  it  occupies  only 
the  space  between  the  tentorium  and  the  posterior  fossae  of 
the  basis  of  the  cranium.  It  is  divided  into  two  hemispheres 
or  lobes  by  the  falx  minor.  Though  covered  by  the  same 
membranes,  its  appearance  differs  from  that  of  the  cerebrum 
in  consequence  of  its  convolutions  being  straight  and  thin, 
and  resembling  horizontal  laminae.  The  latter  are  separated 
by  fissures  penetrating,  from  four  to  twelve  lines,  and  thereby 
increasing  the  surface  for  the  entrance  and  exit  of  the  ves- 
sels. The  upper  surface  of  the  cerebellum  is  slightly  con- 
vex, corresponding  with  the  concavity  of  the  tentorium. 
The  under  surface  has  a double  convexity  corresponding 
with  the  double  concavity  in  the  inferior  part  of  the  occipital 
bone.  The  upper  central  part  of  it,  just  above  the  fourth 
ventricle  is  called  Vermis  Superior ; the  anterior  extremity 
of  which  is  called  the  Monticulus  Cerebelli  from  its  elevation; 
and  when  the  two  hemispheres  are  separated  below,  a promi- 
nence like  a third  lobe  is  seen  between  them,  which  is  the 
Vermis  Inferior.  This  central  part  of  the  cerebellum  is  the 
fundamental  portion  of  Gall. 


56 


OF  THE  CEREBELLUM. 


A View  of  the  Superior  Face  of  the  Cerebellum. 


Fig.  6. 


1. 1.  The  Circumference  of 
the  Cerebellum. 

2.  The  Space  between  its 
Hemispheres  behind. 

3.  One  of  the  Hemispheres 
of  the  Cerebellum,  show- 
ing- the  Laminae  which 
compose  it.  ’ 

4.  The  Vermis  Superior. 

5.  The  Tubercula  Quadri- 
gemina. 

6.  Section  of  the  Crura 
Cerebri. 


When  the  cerebellum  is  cut  into,  the  medullary  matter  is 
found  principally  in  its  centre,  and  sends  off  processes  in 
every  direction  into  the  cortical.  From  this  circumstance 
the  medullary  matter  has  an  arborescent  outline  upon  all 
vertical  sections  made  into  the  cerebellum,  and  has  obtained 
the  name  of  Arbor  Vitae,  which  is  merely  expressive  of  this 
arrangement  without  designating  any  particular  part  of  it. 
If  horizontal  cuts  be  made,  the  arbor  vitae  resemblance  is  not 
manifested,  and  the  proportion  of  medullary  matter  appears 
more  considerable.  The  two  Crura  of  the  Cerebellum  one 
on  a side  pass  from  the  medullary  portion,  being  in  fact  a 
mere  continuation  of  the  latter.  They  are  separated  from 
each  other  by  the  fourth  ventricle  and  are  lost  in  the  poste- 
rior upper  part  of  the  Pons  Varolii.  In  their  centre  is  a 
denticulated  oval  ring  of  cineritious  matter  called  Corpus 
Dentatum  or  Rhomboideum. 

The  Medulla  Oblongata  also  called  Bulbus  Rachidicus 
is  that  portion  of  encephalic  substance,  which  extends  from 
the  middle  of  the  basilar  process  of  the  os  occipitis  to  the 
superior  margin  of  the  first  cervical  vertebra.  Being  a con- 
tinuation of  the  medulla  spinalis,  it  becomes  gradually  larger 
as  it  ascends  and  is  about  one  inch  long.  On  its  under 
surface  it  is  divided  longitudinally  by  the  middle  fissure, 
which  is  continuous  with  that  on  the  front  of  the  medulla 
spinalis.  On  each  side  of  this  fissure,  is  an  oblong  eminence 
called  Corpus  Pyramidale,  coming  to  a point  below,  and 


BRAIN  AND  SPINAL  MARROW. 


57 


disappearing  gradually.  On  the  outer  side  of  that  again, 
and  separated  from  it  by  a fissure  on  the  side  of  the  medulla 
oblongata,  is  an  ovoidal  and  still  more  prominent  convexity, 
but  not  so  long,  called  Eminentia  Olivaris.  And  on  the 
outside  of  this,  is  another  and  smaller  eminence,  the  Corpus 
Pyramidale  Laterale,  or  Corpus  Restiforme.  The  Medulla 
Oblongata  consists  of  medullary  matter  externally,  and  has 
some  cineritious  internally.  By  lifting  it  up  from  the  cere- 
bellum and  dissecting  away  the  tunica  arachnoidea  and  pia 
mater,  a good  view  may  be  got  of  the  Fourth  Ventricle  of 
the  brain,  which  is  closed  below  and  separated  from  the 
spinal  canal  by  these  membranes.  It  will  now  be  easy  to 
understand  that  the  parietes  of  the  fourth  ventricle  are  formed 
by  the  valve  of  Vieussens  and  by  tire  cerebellum,  above  and 
posteriorly;  by  the  pons  Varolii  anteriorly;  by  the  medulla 
Oblongata  below;  and  by  the  Crura  Cerebelli  laterally. 
The  superior  face  of  the  medulla  is  excavated  between  the 
Corpora  Restiformia  and  marked  by  an  arrangement  of  its 
surface  corresponding  in  some  measure  with  the  slit  and  nib 
of  a writing  pen,  from  which  it  has  the  name  of  Calamus 
Scriptorius. 

The  Pons  Varolii  is  the  large  projecting  body  placed  at 
the  top  of  the  medulla  oblongata,  upon  the  junction  of  the 
body  of  the  sphenoid  bone  with  the  basilar  process  of  the  os 
occipitis,  between  the  anterior  part  of  the  cerebellum  and 
the  posterior  part  of  the  middle  lobes  of  the  cerebrum.  It 
is  hemispherical  on  its  inferior  surface- — about  an  inch  in 
diameter  and  divided  into  two  halves  by  a superficial  mid- 
dle longitudinal  fossa,  with  transverse  medullary  fibres  passing 
from  it  on  each  side,  which  come  from  the  Crura  Cerebelli. 
In  its  substance  is  much  cineritious  matter  blended  with 
medullary,  the  latter  being  arranged  in  striae  which  run  in 
different  directions  and  may  be  traced  to  the  Crura  Cerebri. 

In  advance  of  the  Pons  Varolii  and  springing  from  it  are 
two  diverging  medullary  trunks,  one  on  each  side  which 
run  forward  and  are  lost  in  the  medullary  matter  of  the 
Cerebrum.  These  trunks  are  the  Crura  Cerebri.  They 
are  rounded  below,  about  eight  lines  long  and  ten  in  their 
vertical  diameter,  diverge  mutually  from  their  roots  and  are 
separated  by  a deep  fissure  which  is  considered  as  a repeti- 
tion of  that  on  the  front  of  the  Medulla  Oblongata.  Each 


58 


BRAIN  AND  SPINAL  MARROW. 


crus  presents  on  its  surface  a medullary  layer  to  which  suc- 
ceeds a parcel  of  cineritious  matter  which  on  being  removed 
is  followed  by  a mixture  of  both  cineritious  and  medullary 
matter  more  abundant  than  either  of  the  preceding. 

A View  op  the  Base  of  the  Cerebrum  and  Cerebellum,  together  with 
their  Nerves. 

Fig  7. 


1.  Anterior  Extremity  of  the  Fis- 
sure of  the  Hemispheres  of  the 
Brain. 

2.  Posterior  Extremity  of  the  same 
Fissure. 

3.  The,  Anterior  Lobes  of  the 
Cerebrum. 

4.  Its  Middle  Lobe. 

5.  The  Fissure  of  Sylvius. 

6.  The  Posterior  Lobe  of  the  Cere- 
brum. 

7.  The  Point  of  the  Infundibulum. 


8.  Its  Body. 

9.  The  Corpora  Albicantia. 

10.  Cineritious  Matter. 

11.  The  Crura  Cerebri. 

]2.  The  Pons  Varolii. 

13.  The  top  of  the  Medulla  Oblon- 
gata. 

14.  Posterior  Prolongation  of  the 
Pons  Varolii. 

15.  Middle  of  the  Cerebellum. 

16.  Anterior  part  of  the  Cerebel- 
lum. 


BRAIN  AND  SPINAL  MARROW. 


59 


17.  Its  Posteiior  part  and  the  Fis- 
sure of  its  Hemispheres. 

18.  Superior  part  of  the  Medulla 
Spinalis. 

19.  Middle  Fissure  of  the  Medulla 
Oblongata. 

20.  The  Corpus  Pyramidale. 

21.  The  Corpus  Rcstiforme. 

22.  The  Corpus  Olivare. 

23.  The  Olfactory  Nerve. 

24.  Its  Bulb. 

2.5.  Its  External  Root. 

26.  Its  Middle  Root. 

27.  Its  Internal  Root. 

28.  The  Optic  Nerve  beyond  the 
Chiasnr. 


29.  The  Optic  Nerve  before  the 
Chiasm. 

30.  The  Motor  Oculi,  or  Third  Pair 
of  Nerves. 

31.  The  Fourth  Pair,  or  Pathetic 
Nerves. 

32.  The  Fifth  Pair,  or  Trigeminus 
Nerves. 

33.  The  Sixth  Pair,  or  Motor  Ex- 
ternus. 

34.  The  Facial  Nerve. 

35.  The  Auditory — the  two  making 
the  Seventh  Pair. 

36.  37.  38.  The  Eighth  Pair  of 
Nerves.  (The  Ninth  Pair  are 
not  here  seen.) 


Between  the  Crura  Cerebri  at  their  anterior  part  are  two 
small  round  bodies,  three  lines  thick,  in  contact  with  each 
other  and  about  the  size  of  a French  pea;  they  are  the  Cor- 
pora Albicantia  or  Eminentise  Mamillares  and  are  formed  of 
medullary  matter  without  and  cortical  within. 

The  Pons  Tarini,  or  Tuber  Cinereum,  is  a portion  of  the 
under  surface  of  the  crura  cerebri,  at  the  floor  of  the  third 
ventricle.  It  is  continuous  in  front  with  the  anterior  margin 
of  the  Corpus  Callosum. 

The  Infundibulum  is  a flat  funnel-shaped  tube  alluded 
to  in  the  account  of  the  third  ventricle,  but  best  seen  in  this 
period  of  the  dissection.  It  is  placed  just  before  the  corpora 
adbicantia,  and  passes  from  the  third  ventricle  to  the  pituitary 
gland,  having  its  apex  in  contact  with  the  latter,  and  its 
broad  part  opening  into  the  ventricle.  It  is  generally  im- 
pervious at  its  apex.  It  is  cineritious  externally,  which 
gives  it  a red  cast,  and  medullary  internally. 

The  Glandula  Pituitaria  occupies  the  sella  turcica,  and 
is  somewhat  spherical,  being  about  six  or  seven  lines  in 
diameter.  Its  structure  is  firm  and  resisting,  formed  of  a 
tough  cineritious  matter  externally,  and  of  a kind  of  me- 
dullary internally.  It  is  almost  concealed  by  a close  reflec- 
tion of  dura  mater  over  it. 


NERVES  OF  THE  BRAIN. 

There  are  Nine  pairs  of  nerves  going  from  the  basis  of  the 
brain,  and  named  numerically  by  beginning  in  front.  • 


60 


NERVES  OF  THE  BRAIN. 


The  1st  Pair,  the  Olfactory  (Nervi  Olfactorii,)  ap- 
propriated to  the  nose,  arise  by  three  medullary  striae  from 
the  base  of  the  brain  at  the  corpora  striata,  in  the  fissure  of 
Sylvius  and  make  their  appearance  on  the  back  and  inferior 
part  of  the  anterior  lobes.  Their  structure  is  soft  and  pulpy, 
and  they  are  protected  from  the  weight  of  the  brain  by  being 
deposited  in  a triangular  groove  formed  by  a convolution. 
They  swell  out  into  bulbs  at  their  fore  part  on  the  sides  of 
the  crista  galli,  and  perforate  the  cribriform  plate  of  the 
cethmoid  bone  by  numerous  filaments.  They  get  a coat 
from  the  dura  mater  which  gives  them  great  strength,  and 
are  then  distributed  as  mentioned  in  the  account  of  the 
nose. 


A View  of  the  Second  Pair  or  Optic  Nerves,  with  the  origin  of  Seven 
other  Pairs  of  Nerves. 


Fig.  8. 


I. 1.  Globe  of  the  Eye;  the 

one  on  the  Left  Hand  is 
perfect,  but  that  on  the 
Right  has  the  Sclerotic 
and  Choroid  Coats  re- 
moved in  order  to  show 
the  Retina. 

2.  The  Chiasm  of  the  Op- 
tic Nerves. 

3.  The  Corpora  Albicantia. 

4.  The  Infundibulum. 

5.  The  Pons  Varolii. 

6.  The  Medulla  Oblongata. 

7.  The  Third  Pair,  Motores 
Oculi. 

8.  Fourth  Pair,  Pathetici. 

9.  Fifth  Pair,  Trigemini. 

10.  Sixth  Pair,  Motor  Ex- 
tern us. 

II.  Seventh  Pair,  Auditory 
and  Facial. 

12.  Eighth  Pair,  Pneumo- 
gastric,  Spinal  Accessory 
and  Glosso-PharyngeaL 

13.  Ninth  Pair,  Hypoglossal. 


The  2d  Pair,  the  Optic  Nerves  (Nervi  Optici,)  are  of 
considerable  magnitude,  and  differ  somewhat  in  their  texture 
from  the  other  nerves  in  consequence  of  having  a general 
investment  of  pia  mater  before  it  surrounds  their  particular 
fasciculi ; and  also  from  having  more  medullary  matter  in 


NERVES  OF  THE  BRAIN. 


61 


them.  They  arise  from  the  posterior  end  of  the  thalami  and 
from  the  testes,,  and  make  their  appearance  between  the 
middle  lobes  and  the  crura  cerebri.  There  is  a very  close 
intertexture  of  the  nerves  of  the  opposite  sides  just  before 
the  infundibulum,  so  that  it  is  a question  whether  they 
decussate  each  other,  or  simply  unite.  This  junction  pre- 
sents the  shape  of  the  letter  X,  and  is  called  the  Chiasm  or 
Crossing  of  the  Optic  Nerves.  Being  the  nerves  of  vision, 
they  pass  to  the  ball  of  the  eye,  through  the  foramina  optica 
and  are  expanded  into  the  retina. 

The  3d  Pair,  (Motores  Oculorum,)  arise  from  the  inner 
margins  of  the  crura  cerebri  near  the  pons  varolii  by  several 
filaments.  They  pass  outwards  and  penetrate  the  dura 
mater  near  the  posterior  clinoid  process,  and  traversing  the 
upper  part  of  the  cavernous  sinus  they  get  into  the  orbits 
through  the  foramen  sphenoidale.  They  are  distributed  to 
the  muscles  of  the  eye,  except  the  obliquus  superior  and 
rectus  externus,  and  contribute  to  the  ophthalmic  ganglion. 

The  4th  Pair,  (Trochleares.)  each  arise  by  two  fila- 
ments which  quickly  unite,  from  the  valve  of  Vieussens  just 
below  the  testes.  It  is  the  smallest  cranial  nerve  and  is  not 
larger  than  a common  sewing  thread  ; it  makes  its  appear- 
ance at  the  anterior  lateral  margin  of  the  pons  varolii.  It 
penetrates  the  edge  of  the  tentorium  not  far  from  the  entrance 
of  the  third  nerve,  and  running  in  an  investment  of  dura 
mater  through  the  cavernous  sinus  at  the  outer  side  of  this 
nerve,  it  afterwards  crosses  it  above,  and  getting  into  the 
orbit  through  the  foramen  sphenoidale,  is  appropriated  to 
the  trochlearis  or  superior  oblique  muscle. 

The  5th  Pair,  (Trigemini,)  are  the  largest  of  all.  Each 
arises  by  three  portions,  the  middle  being  largest,  from  the 
side  of  the  tuber  annulare  just  where  it  is  blended  with  the 
crus  cerebelli.  Their  fibres  may  be  traced  through  the 
pons  into  the  posterior  column  of  the  medulla  oblongata  and 
are  collected  into  one  cord,  which  passes  into  a canal  of  the 
dura  mater,  lying  on  the  anterior  part  of  the  petrous  bone. 
They  are  not  connected  to  the  canal  except  at  its  lowest  part, 
w'here  they  receive  a coat  from  it.  The  nerve  is  then  ex- 
panded like  a fan,  into  seventy  or  eighty  filaments.  At  the 
lower  end  of  the  latter  is  a brownish  substance,  called  the 


62 


NERVES  OF  THE  BRAIN. 


ganglion  of  Gasser,  formed  principally  upon  the  middle  root 
of  the  Trigeminus.  The  nerve  then  passes  off  in  three  great 
divisions,  named  from  their  appropriations;  1st,  the  Oph- 
thalmic nerve  which  goes  out  of  the  cranium  at  the  foramen 
sphenoidale  of  the  orbit ; 2d,  the  superior  Maxillary,  at  the 
foramen  rotundum ; and  3d,  the  Inferior  Maxillary,  at  the 
foramen  ovale.  Its  general  distribution  is  to  the  orbit,  the 
face  and  the  tongue. 

The  6th  Pah,  (Motores  Externi.)  Each  nerve  arises 
from  the  commencement  of  the  medulla  oblongata  in  the 
base  of  the  corpus  pyramidale,  its  root  being  frequently 
overlapped  by  the  pons.  It  passes  forward  through  the 
dura  mater,  in  a canal,  of  the  cavernous  sinus,  on  the  inside 
of  the  fifth  nerve,  and  lying  between  this  nerve  and  the 
carotid  artery,  it  detaches  one  or  more  filaments  to  form  the 
commencement  of  the  sympathetic  nerve,  and  which  accom- 
panies the  carotid  artery  through  the  carotid  canal  to  the 
neck.  The  trunk  of  the  motor  externus  then  gets  into  the 
orbit  through  the  foramen  sphenoidale  and  is  appropriated 
to  the  rectus  externus  muscle  of  the  eye. 

The  7th  Pair,  is  composed  of  two  nerves,  the  Portio 
Mollis  and  the  Portio  Dura.  The  first  arises  from  the 
posterior  face  of  the  medulla  oblongata,  at  the  calamus 
scriptorius  and  corpus  restiforme,  being  separated  from  its 
fellow  of  the  opposite  side  by  the  slit  of  the  calamus  scripto- 
rius. The  second,  or  portio  dura,  arises  from  the  superior 
part  of  the  corpus  restiforme  behind,  near  the  pons.  A third 
nerve,  which  at  a little  distance  joins  the  portio  dura  and 
is  a mere  fibril  of  it  called  portio  Media,  arises  near  the  lat- 
ter. The  seventh  nerve,  thus  constituted  of  a hard  and  of 
a pulpy  portion,  dips  into  the  meatus  auditorius  internus. 
The  mollis  goes  to  the  ear  and  is  spent  upon  the  labyrinth ; 
the  dura,  passing  along  the  aqueduct  of  Fallopius,  gets  out 
at  the  stylo-mastoid  hole  and  goes  to  the  face. 

The  8th  Pair,  consists  of  three  portions  having  different 
destinations:  The  Glosso-Pharyngeal ; The  Par  Yagum  or 
Peumo-gastric- ; and  the  Spinal  Accessory- nerve  of  Willis. 
The  first  two  arise  near  each  other  behind  the  Corpora  Oli- 
varia  from  the  side  of  the  Medulla  Oblongata.  The  Glosso- 


BRAIN  AND  SPINAL  MARROW. 


63 


Pharyngeal  is  before  the  other,  and  consists  of  one  cord. 
The  Par  Vagum  is  composed  of  several  fasciculi  having  a 
flattened  appearance,  which  afterwards  unite  together.  The 
Spinal  Accessory  has  a remarkable  origin  from  the  posterior 
fasciculus  of  the  Medulla  spinalis,  occasionally  as  low  down 
as  the  seventh  cervical  nerve.  Its  fibres  successively  form 
a round  trunk,  which  passing  up  the  spinal  canal  and  then 
into  the  cavity  of  the  cranium  through  the  foramen  magnum, 
is  associated  with  the  nerves  just  mentioned;  it  is  assisted 
also  by  contributions  from  the  side  of  the  Medulla  Oblon- 
gata. ' The  eighth  pair  passes  out  of  the  cranium  at  the  pos- 
terior foramen  lacerum,  anterior  to  the  internal  jugular  vein, 
and  separated  from  it  by  a spine  of  bone  as  well  as  by  a 
process  of  dura  mater.  The  distinction  of  the  nerves  from 
each  other  is  also  kept  up  here,  by  processes  of  dura  mater 
between  them.  They  adhere  on  the  outside  of  the  cranium 
and  then  part  for  their  different  destinations ; the  Glosso- 
pharyngeal for  the  tongue  and  pharynx,  the  Par  Vagum  for 
the  lungs  and  stomach,  and  the  Spinal  Accessory  for  the 
muscles  and  integuments  of  the  neck. 

The  9th  Pair,  (Hypoglossi.)  Each  nerve  arises  from 
the  side  of  the  medulla  oblongata  in  the  groove,  between 
the  corpus  pyramidal  and  olivare,  by  three  or  four  fasciculi. 
These  fasciculi  unite  into  a trunk,  which  gets  from  the  cra- 
nium through  the  anterior  condyloid  foramen,  and  is  dis- 
tributed to  the  tongue. 

OF  THE  BLOOD-VESSELS  OF  THE  BRAIN  AND 
SPINAL  MARROW. 

The  brain  is  supplied  by  the  Internal  Carotids  and  the 
Vertebral  Arteries.  The  former,  passing  in  a very  tortuous 
manner  through  the  canal  in  the  temporal  bones,  appear  in 
the  cavernous  sinus  at  the  sides  of  the  anterior  clinoid  pro- 
cesses. They  there  send  off,  each  anteriorly,  the  ophthalmic 
artery  through  the  optic  foramen,  and,  in  a short  space  after- 
wards, the  Arteria  Communicans  Posterior,  a branch  which 
goes  backwards  to  join  the  posterior  artery  of  the  cerebrum; 
the  main  trunk  is  continued  into  the  fissure  of  Sylvius,  and 
forms  the  Arteria  Media  Cerebri,  and  from  this  is  sent  off 
the  Arteria  Anterior  which  supplies  the  anterior  lobe  of  the 


64 


OF  THE  HEAD  AND  NECK. 


brain  and  the  corpus  callosum.  The  arteria  anterior  com- 
municates by  a short  transverse  branch,  the  Communicans 
Anterior,  with  its  fellow. 

A V iew  of  the  Circle  of  Willis. 

Fig.  9. 


1.  The  Vertebral  Arteries. 

2.  The  two  Anterior  Spinal 
Branches. 

3.  One  of  the  Posterior  Spinal  ar- 
teria. 

4.  The  Posterior  Meningeal  Ar- 
tery. 

5.  The  Inferior  Cerebelli  Artery. 

6.  The  Basilar  Artery. 

The  Vertebral  Arteries  come  up  through  the  foramen 
magnum  and  unite  with  each  other  at  the  posterior  part  of 
the  pons  varolii,  to  form  the  basilary  artery. 


7.  The  Superior  Cerebelli  Artery. 

8.  The  Posterior  Cerebelli. 

9.  The  Posterior  Communicans. 

10.  The  Internal  Carotid. 

11.  The  Ophthalmic  Artery. 

12.  The  Middle  Cerebral  Artery. 

13.  The  Anterior  Cerebri. 

14.  The  Anterior  Communicans. 


BRAIN  AND  SPINAL  MARROW.  65 

The  Basilar  artery  divides  anteriorly  into  two  branches, 
which  run  to  the  posterior  lobes  of  the  brain ; they  consti- 
tute the  Arterise  Posteriores  Cerebri.  From  the  basilar 
near  the  vertebrals,  on  each  side,  arises  a trunk,  the  Arte- 
teria  Inferior  Cerebelli ; and  from  its  anterior  part  the  Arte- 
ria  Superior  Cerebelli.  This  arterial  link  is  called  the  Cir- 
cle of  Willis,  and  is  formed  as  we  have  seen,  by  the  anterior 
bifurcation  of  the  basilar,  with  the  internal  carotids  and  the 
arteriie  communicantes.  It  encloses  the  chiasm  of  the  op- 
tic nerves,  and  the  emminentia  mammillares. 

The  veins  of  the  brain  have  been  mentioned,  as  all  emp- 
tying into  the  sinuses  of  the  dura  mater. 

OF  THE  MEDULLA  SPINALIS. 

The  Spinal  Marrow  is  placed  in  the  vertebral  canal,  and 
starting  from  the  first  vertebra  of  the  neck,  passes  down 
as  far  as  the  first  or  second  vertebra  of  the  loins ; and  there 
terminates  in  a conical  point. 

It  has  the  same  number  of  membranes  with  the  Brain; 
to  wit,  the  Dura  Mater,  Tunica  Arachnoidea  and  Pia 
Mater. 

The  Dura  Mater  resembles  very  much  the  same  membrane 
of  the  brain,  except  that  it  has  more  elasticity.  It  does  not 
adhere  closely  to  the  spinal  canal,  but  lies  loosely  envelop- 
ing the  spinal  marrow  and  nerves,  until  it  touches  the  fora- 
mina through  which  the  latter  pass  out.  Between  the  spi- 
nal canal  and  the  dura  mater,  is  interposed  a soft,  watery 
and  vascular  fat,  which  forms  a sort  of  bed  for  the  dura 
mater,  and  fills  up  many  of  the  inequalities  of  the  canal.  At 
the  egress  of  the  dura  mater  from  the  cranium,  just  around 
the  foramen  magnum,  it  adheres  very  closely  to  it  and  also 
to  the  first  cervical  vertebra. 

The  Pia  Mater  is  in  close  union  with  the  Medulla  Spi- 
nalis, and  is  commonly  found  with  its  veins  injected  after 
the  same  way,  with  the  pia  mater  of  the  brain ; it  is,  how- 
ever, not  so  vascular,  and  ends  by  a conical  cord  below, 
which  goes  to  the  lower  end  of  the  sacrum,  with  the  dura 
mater. 

The  Tunica  Arachnoidea,  lies  loosely  between  the  dura 

5 


66 


OF  THE  HEAD  AND  NECK. 


and  the  pia  mater,  preserving  a character  of  extreme  tenuity 
and  transparency ; it  may  be  elevated  any  where  wTith  a 
pair  of  forceps ; continues  downwards  to  the  end  of  the 
spinal  cavity,  and  connects  the  fasciculi  of  nerves  together. 

On  each  side  of  the  spinal  marrow  running  between  the 
anterior  and  posterior  fasciculi  of  nerves,  is  a narrow 
semitransparent  band,  called  Ligamentum  Denticulatum, 


Fig.  10. 


An  Anterior  View  of  the  Spinal  Mar- 
row, SEEN  IN  ITS  WHOLE  LENGTH  AFTER 
REMOVAL  FROM  THE  SPINAL  CANAL. 

1.  Lines  indicating  the  Corpora  Pyrami- 

dalia. 

2.  Eminentia  Olivaria. 

3.  Anterior  Face  of  the  Spinal  Marrow. 

4.  Anterior  Roots  of  the  Cervical  Spinal 

Nerves. 

5.  Anterior  Roots  of  the  Dorsal  Nerves. 

G.  Anterior  Roots  of  the  Lumbar  Nerves. 

7.  Anterior  Roots  of  the  Sacral  Nerves. 

8.9.10.11.  The  Anterior  and  Posterior  Roots 
of  the  Spinal  Nerves,  united  to  pass 
out  of  the  Dura  Mater. 

1 2.  Dura  Mater  of  the  Medulla  Spinalis. 

13.  Ganglia  on  the  Cervical  Nerves. 

14.  Ganglia  on  the  Dorsal  Nerves. 

15.  Ganglia  on  the  Lumbar  Nerves. 

16.  Ganglia  on  the  Sacral  Nerves. 

17.  Cauda  Equinoe. 

18.  Sub-Occipital  Nerve. 

19.  Ligamentum  Denticulatum. 


BRAIN  AND  SPINAL  MARROW. 


67 


fixed  beneath  the  tunica  ar- 
achnoidea,  and  connected  to 
the  pia  mater  by  its  internal 
margin.  It  is  first  observed 
arising  at  the  occipital  fora- 
men ; it  then  descends,  and 
as  it  passes  between  the  ante- 
rior and  posterior  fasciculi  of 
nerves,  it  detaches  many  lit- 
tle round  tooth-like  processes, 
fixed  to  the  inner  surface  of 
the  dura  mater,  and  carrying 
the  tunica  arachnoidea  along 
with  them.  From  these  pro- 
cesses it  derives  its  name. 

The  Medulla  Spinalis  like 
the  brain  consists  of  two  kinds 
of  matter,  cineritious  and  me- 
dullary. But  the  latter  is 
here  placed  externally. 

The  medulla  spinalis  has 
anteriorly  and  posteriorly,  a 
fissure  penetrating  almost  to 
its  centre,  and  extended  its 
whole  length,  which  divides 
it  into  two  equal  parts.  These 
halves  are  again  divided  each 
into  an  anterior  and  posterior 
column,  by  a lateral  fissure, 
which  is  not  so  deep  or  long 
as  the  other,  but  terminates  in 
the  thoracic  portion  of  the 
canal,  and  is  nearer  the  poste- 
rior than  the  anterior  fissure. 


Fig.  11. 


An  Anterior  View  of  the  Spinal  Marrow,  Medulla  Oblongata, 
&c.,  of  a new-born  Infant. 


1.  The  Pituitary  Gland. 

2.  The  Infundibulum. 

3.  The  Optic  Nerves. 

4.  The  Corpora  Albicantia. 

5.  Crura  Cerebri. 

6.  The  triangular  space  between 

the  Crura. 


7.  Corpus  Geniculatum  Internum, 

8.  Corpus  Geniculatum  Externum. 

9.  Posterior  portion  of  the  Thalami 

Nervi  Optici. 

10.  Pons  Varolii. 

11.  Its  prolongation  into  the  Crus 

Cerebelli. 


68- 


OF  THE  HEAD  AND  NECK. 


12.  Eminentia  Olivaria.  15.  Anterior  Middle  Fissure  of  the 

13.  Corpora  Pyramidalia.  Spinal  Marrow. 

14.  Corpus  Restiforme.  16.  Enlargement  for  the  Origin  of 

the  Lumbar  nerves. 


The  posterior  column  is  again  divided  into  two.  These 
several  divisions  of  the  spinal  marrow  being  connected  by 
the  internal  cineritious  matter,  when  a horizontal  cut  is  made, 
the  latter  puts  on  the  appearance  of  a line  with  a crescent  at 
each  end.  At  the  upper  end  of  the  medulla  spinalis  near  the 
oblongata,  a considerable  part  of  the  anterior  portions  or 
columns,  crosses  from -the  side  to  which  they  belong  to  the 
opposite  one,  and  in  doing  so  they  are  interwoven.  This  de- 
cussation or  crossing  is  known  as  that  of  Petit  or  Mitischelli. 

Fig.  12. 


An  Anterior  View  of  the  Me- 
dulla Oblongata  and  of  the 
Termination  of  the  Decus- 
sation of  Mitischelli. 

1 . The  Pons  Varolii. 

2.  The  Eminentia  Olivaria. 

3.  The  Corpus  Pyramidale. 

4.  The  Corpus  Restiforme. 

5.  The  DecussatioD  of  Mitischelli. 

6.  The  Anterior  Columns  of  the 

Spinal  Marrow. 

7.  The  Lateral  Columns. 


In  the  bottom  of  the  anterior  fissure  there  is  a commissure 
of  transverse  fibres,  said  to  be  like  the  teeth  of  a saw ; and  at 
the  bottom  of  the  posterior  fissure,  there  is  a commissure 
of  longitudinal  fibres,  these  are  called  anterior  and  poste- 
rior Commissures. 

From  the  anterior  and  posterior  portions  of  the  spinal 
marrow,  flat  fasciculi  of  nerves  proceed  by  double  roots  which 
penetrate  the  dura  mater  separately,  and  derive  a coat  from 
it.  This  coat  exists  for  some  distance  as  a sheath,  united 
to  the  nerve  by  loose  cellular  substance,  but  is  closely  fixed 
to  it  near  the  intervertebral  foramen.  The  posterior  fasci- 
culus, at  this  place,  forms  a ganglion,  which  sends  out  a 
nerve  at  its  fore  part ; this  nerve,  just  at  its  origin,  is 
united  to  the  anterior  fasciculus,  and  thus  forms  the  com- 


EE  A IN  AND  SPINAL  MARROW. 


69 


mencement  of  the  spinal  nerve.  As  soon  as  the  spinal  nerve 
clears  the  foramen  between  the  bones,  it  sends  branches 
backwards  to  the  muscles  of  the  spine,  others  forwards 
to  join  the  sympathetic,  and  the  middle  trunk  goes  ac- 
cording to  the  part  of  the  body  to  be  supplied. 


A View  of  a small  portion  of 
the  Spinal  Marrow,  showing 
the  Origins  of  some  of  the 
Spinal  Nerves. 

1.  The  Anterior  or  Motor  Root  of 

a Spinal  Nerve. 

2.  The  Posterior  or  Sensory  Root 

of  a Spinal  Nerve. 

3.  The  Ganglion  connected  with 

the  latter. 

There  are  thirty  pairs  of  spinal  nerves;  seven  to  the  neck, 
twelve  to  the  back,  five  to  the  loins,  five  to  the  sacrum,  and 
one  which  passes  between  the  occiput  and  first  vertebra 
called  Sub-Occipital.  The  nerves  of  the  neck,  from  their 
origin  to  the  intervertebral  foramina,  are  short  and  nearly 
horizontal ; those  of  the  back  pass  obliquely  downwards,  in- 
creasing in  obliquity  as  they  descend.  The  lumbar  and 
sacral  nerves  are  extremely  oblique,  the  lowest  being  almost 
vertical ; they  arise  very  much  in  a cluster,  close  to  each 
other,  and  form,  while  still  within  the  dura  mater,  the  Cauda 
Equina. 

The  Arteries  of  the  Spinal  Marrow  are  derived  from  eht 
vertebrals,  intercostals,  lumbar  and  sacral  arteries.  The 
veins  accompany  the  arteries  and  form  sinuses  on  the 
outside  of  the  dura  mater,  one  on  each  side,  which  empty 
into  the  occipital  and  lateral  sinuses,  anastomosing  however 
very  freely,  with  a plexus  of  veins  which  surrounds  the  spi- 
nal column. 


Fig.  13. 


70 


OF  THE  HEAD  AND  NECK. 


SECTION  II. 


Of  the  Muscles  and  Fasciae. 


The  Occipito-frontalis,  a single  muscle,  consists  of 
two  symmetrical  parts,  and  coming  from  the  back  of  the 
head,  is  inserted  into  the  front  of  it.  It  is  superficial,  being 
placed  immediately  below  the  skin  of  the  scalp ; and  has 
four  bellies  of  muscular  fibres,  two  behind  and  two  before, 
connected  by  a thin  tendon  which  covers  all  the  top  of  the 
head.  The  dissection  of  this  muscle  is  difficult,  from  the 
close  adhesion  of  its  tendon  t<  11  ericranium  below,  and 


to  replace  the  scalp,  and  commence  by  making  one  incision 
through  the  integuments  only,  from  the  root  of  the  nose  to 
the  fore  end  of  the  sagittal  suture,  and  another  from  the 
commencement  of  the  first  along  the  upper  margin  of  each 
eyebrow,  to  the  external  angular  process  of  the  os  frontis ; 
by  raising  up  this  flap  and  enlarging  it  in  an  appropriate 
manner  on  each  side,  it  leads  to  the  dissection  of  the  whole 
muscle. 

It  arises  from  the  superior  semicircular  ridge  of  the  os 
occipitis,  by  tendinous  and  fleshy  fibres  which  form  two  dis- 
tinct bellies,  (Musculus  Occipitalis,)  about  an  inch  and  a half 
long,  one  on  each  side  of  the  bone.  Its  tendon,  when  care- 
fully traced,  will  be  found  terminating  a little  in  front  of  the 
coronal  suture,  in  the  two  anterior  fleshy  bellies,  (Musculus 
Frontalis,)  which  cover  the  whole  front  paid  of  the  es  frontis. 
The  internal  edges  of  these  latter  are  in  conjunction  below. 

It  is  inserted  fleshy  on  each  side,  into  the  superior 
margin  of  the  orbicularis  oculi  and  of  the  corrugator  su- 
percilii,  and  by  its  nasal  slip,  into  the  internal  angular  pro- 
cess of  the  os  frontis  and  into  the  root  of  the  os  nasi. 

It  pulls  the  skin  of  the  head  backwards  and  forwards, 
and  throws  that  of  the  forehead  into  horizontal  wrinkles.  It 
also  elevates  the  supercilia. 

Its  fleshy  portion  is  said  to  have  covered,  in  some  in- 
stances the  whole  skull  cap. 

The  Compressor  Naris  arises  by  a pointed  beginning 


to  the  ‘common  integuments 


It  is  best  therefore, 


MUSCLES  AND  FASCIAL 


71 


from  the  root  of  the  ala  nasi ; it  spreads  like  a fan  over  the 
lateral  parts  of  the  nose  below,  is  inserted  into  its  fellow  of 
the  opposite  side  on  the  dorsum  of  the  nose,  and  into  the 
lower  part  of  the  os  nasi,  where  it  is  connected  with  the 
nasal  slip  of  the  occipito-frontalis. 

This  muscle  consists  of  thin  and  pale  fibres  placed  imme- 
diately under  the  skin.  If  it  act  from  both  extremities  by 
its  curved  fibres  being  made  straight,  it  will  compress  the 
nostril ; but  if  it  act  from  its  dorsal  margin  assisted  by  the 
nasal  slip  of  the  occipito-frontalis,  it  will  dilate  the  ala  nasi, 
and  has,  therefore,  been  called  Dilatans  Nasum  by  Co- 
lumbus. 

The  Orbicularis  Palpebrarum  is  a broad  circular  mus- 
cle, lying  immediately  under  the  skin  of  the  eyelids,  and 
over  the  tarsi  cartilages.  It  covers  the  whole  front  of  the 
bony  orbit  and  extends  from  four  to  eight  lines  beyond  its 
margin.  The  fixed  part  of  the  muscle,  is  principally  the 
ligamentum  palpebrale  internum  and  the  internal  canthus 
of  the  orbit,  being  elsewhere  connected  to  subjacent  parts 
by  cellular  tissue ; its  temporal  ^section  is  fastened  to  the 
temporal  fascia  beneath. 

It  arises  fleshy  from  the  internal  angular  process  of  the 
frontal  bone,  from  the  upper  end  of  the  nasal  process  of  the 
os  maxillare  superius  and  the  os  unguis,  and  from  the  su- 
perior edge  of  the  round  horizontal  tendon,  called  internal 
palpebral  ligament,  that  fixes  the  internal  commissure  of  the 
eyelids  to  the  nasal  process  of  the  superior  maxilla.  These 
fibres  perform  the  circuit  of  the  eyelids,  and  coming  around 
to  the  internal  canthus  again,  are  inserted  into  the  orbital 
margin  of  the  nasal  process,  and  into  orbitar  process  of 
the  upper  maxilla,  and  into  the  lowrer  edge  of  the  same  ho- 
rizontal tendon  from  which  it  arose. 

The  Ciliaris  muscle  of  Albinus,  is  the  internal  margin  of 
the  orbicularis,  planted  on  the  edges  of  the  tarsi  cartilages. 

As  the  Orbicularis  muscle  is  fixed  at  its  nasal  and  tem- 
poral portions  more  than  elsewhere,  it  is  obvious  that  the 
contraction  of  its  circular  or  curved  fibres  by  making  them 
straight,  will  close  the  eyelids  and  wrinkle  the  skin  on  them. 
This  muscle  frequently  has  a slip  from  its  lower  border  to 
the  upper  lip,  anterior  to  the  zygomaticus  minor. 


12 


OF  THE  HEAD  AND  NECK. 


A Front  View  of  the  Superficial  Layer  of  Muscles  on  the 


Face  and  Neck. 
Fig.  14. 


1. 1.  Anterior  Bellies  of  the  Oecipito-Frontalis. 

2.  Orbicularis  or  Sphincter  Palpebrarum. 

3.  Nasal  Slip  of  Oecipito-Frontalis. 

4.  Anterior  Aurieute. 

5.  Compressor  Naris. 

6.  Levator  Labii  Superioris  Ateque  Nasi. 

7.  Levator  Anguli  Oris. 

8.  Zygomatieus  Minor. 

9.  Zygomatieus  Major. 

10.  Masseter. 

1 1 . Depressor  Labii  Superioris  Ateque  Nasi. 

12.  Buccinator. 

13.  Orbicularis  Oris. 

14.  The  denuded  surface  of  the  Inferior  Maxillary  Bone, 

15.  Depressor  Anguli  Oris. 

16.  Depressor  Labii  Inferioris. 

17.  The  portion  of  the  Platysma-Myodes  that  passes  on  to  the  Mouth, 

or  the  Musculus  Risorius. 

18.  Sterno-Hyoideus. 

19.  Platysma  Myodes.  It  is  wanting  on  the  other  side  of  the  Figure. 


MUSCLES  AND  FASCIAE. 


73 


20.  Superior  belly  of  the  Omo-Hyoideus  near  its  insertion. 

21.  Sterno-Cleido-Mastoideus. 

22.  Scalenus  Medius. 

23.  Inferior  belly  of  Omo-Hyoideus. 

24.  Cervical  edge  of  the  Trapezius. 

The  Corrugator  Supercilii,  is  placed  beneath  the  up- 
per margin  of  the  orbicularis,  at  the  internal  end  of  the  su- 
perciliary ridge.  It  arises  from  the  internal  angular  process 
of  the  os  frontis,  and  passing  obliquely  upwards  and  out- 
wards, between  the  lower  edge  of  the  occipito-frontalis  and 
the  upper  edge  of  the  orbicularis,  is  concealed  by  them.  It 
is  inserted  into  the  former  principally,  but  its  fibres  also 
blend  with  the  latter. 

It  draws  the  eyebrow  and  skin  of  the  forehead  into  ver- 
tical wrinkles,  and  also  draws  them  over  the  eye  so  as  to 
overshadow  it. 

The  Levator  Labii  Superioris  Alacque  Nasi  is  fixed 
just  at  the  side  of  the  nose.  It  arises  by  a pointed  pro- 
duction, from  the  nasal  process  of  the  os  maxillare  superius 
at  the  internal  canthus  of  the  eye,  and  by  a broad  origin 
from  the  anterior  margin  of  the  orbitar  process  of  the  same 
bone.  Passing  downwards,  it  is  inserted  into  the  side  of 
the  ala  nasi,  and  into  the  upper  lip,  being  narrower  below 
than  above.  The  part  of  this  muscle  which  comes  from 
the  orbitar  process  is  so  distinct,  that  Albinus  and  others 
give  it  the  exclusive  name  of  Levator  Labii  Superioris. 

It  draws  the  upper  lip  and  the  ala  nasi  upwards. 

Just  beneath  this  muscle  there  is  sometimes  a fasciculus, 
called  the  Anomalus  Faciei  of  Albinus,  which  is  attached 
by  one  end  to  the  upper  jaw  near  the  canine  fossa,  and  by 
the  other  to  the  upper  lip. 

The  Levator  Anguli  Oris,  is  a small  muscle  concealed 
very  much  by  the  last ; it  arises  from  the  anterior  part  of 
the  superior  maxillary  bone,  between  the  foramen  infra-or- 
bitarium  and  the  first  small  grinder,  and  is  inserted  into  the 
corner  of  the  mouth. 

It  raises  the  angle  of  the  mouth. 

The  Zigomaticus  Minor,  is  a small  muscle  sometimes 
deficient  and  sometimes  double,  arising  from  the  fore  part 
of  the  os  malae ; it  descends  obliquely  and  is  inserted  into 
the  upper  lip  just  above  the  corner  of  the  mouth. 


74 


OF  THE  HEAD  AND  NECK. 


The  Zigomaticus  Major,  being  on  the  outside  of  the 
last  and  much  larger,  arises  from  the  malar  bone  externally 
at  its  posterior  inferior  part,  just  above  the  lower  edge, 
where  this  bone  contributes  to  form  the  zygoma,  and  pass- 
ing obliquely  downwards,  is  inserted  into  the  corner  of  the 
mouth,  and  runs  into  the  depressor  anguli  oris. 

These  last  two  muscles  draw  the  corner  of  the  mouth  to- 
wards the  cheek  bone,  or  obliquely  upwards  and  outwards, 
as  in  smiling. 

The  Depressor  Labii  Superioris  Alrsque  Nasi,  is  con- 
cealed by  the  orbicularis  oris  and  by  the  levator  labii  supe- 
rioris alaeque  nasi.  To  get  a view  of  it,  the  upper  lip  must 
be  inverted  and  the  lining  membrane  of  the  mouth  removed 
on  the  side  of  the  fraenum  of  the  lip.  This  muscle  arises 
from  the  inferior  part  of  the  upper  maxilla,  in  front  of  the 
alveolar  processes  for  the  dens  caninus  and  tire  incisores, 
and  is  inserted  into  the  side  of  the  ala  nasi  and  into  the  con- 
tiguous part  of  the  upper  lip. 

It  depresses  the  upper  lip  and  the  ala  nasi. 

The  Depressor  Anguli  Oris,  arises  broad  and  fleshy 
from  the  base  of  the  lower  jaw  on  the  side  of  the  chin  ; 
being  somewhat  triangular;  its  apex  is  inserted  into  the  cor- 
ner of  the  mouth. 

This  muscle  draws  the  corner  of  the  mouth  downwards. 
It  lies  immediately  under  the  skin,  and  blends  above  with 
the  zygomaticus  major  and  with  the  levator  anguli  oris. 

The  Depressor  Labii  Inferioris,  is  in  part,  beneath  the 
last  muscle,  and  like  it,  arises  broad  and  fleshy  from  the 
basis  of  the  lower  jaw  on  the  side  of  the  chin ; its  fibres 
pass  obliquely  upwards  and  inwards,  and  are  inserted  into 
the  whole  side  of  the  lower  lip. 

It  draws  the  lip  downwards. 

These  last  two  muscles  are  much  obscured  by  being 
mixed  with  a quantity  of  adipose  matter ; the  skin  also,  is 
closely  blended  with  them,  and  the  roots  of  the  beard  pe- 
netrate between  the  intervals  of  their  fibres. 

Its  exterior  border  is  often  formed  by  the  Platysma- 
Myodes. 


MUSCLES  AND  FASCIiE. 


75 


A.  Front  View  of  the  Deep-seated  Layer  of  Muscles  on  the 
Face  and  Neck. 

Fig.  15. 


1. 1.  Temporalis. 

2.  The  Eye-Ball  in  the  Orbit  with  its  oblique  muscles  in  situ. 

3.  Corrugator  Supercilii. 

4.  Points  of  insertion  of  the  Orbicularis  Palpebrarum. 

5.  Anterior  Auriculae. 

6.  Orbitar  portion  of  the  Levator  Labii  Superioris  Ateque  Nasi. 

7.  Compressor  Naris. 

8.  Levator  Labii  Superioris  in  its  lower  third,  showing  its  intermix- 

ture with  the  Orbicularis  Oris. 

9.  Levator  Anguli  Oris. 

10.11.  Depressor  Labii  Superioris  Alaeque  Nasi,  seen  on  both  sides  of 
the  Face. 

12.  Buccinator. 

13.  Masseter. 

14.  Orbicularis  Oris  at  the  angle  of  the  mouth. 

15.  Orbicularis  Oris  as  shown  in  the  edge  of  the  lower  lip. 

16.  Depressor  Anguli  Oris. 

1 7.  Levator  Menti  vel  Labii  Inferioris. 

18.  Depressor  Labii  Inferioris. 

19.  Adipose  Tissue  on  the  chin. 


76 


OF  THE  HEAD  AND  NECK. 


20.  Scalenus  Medius. 

21.  Sterno-Hyoideus. 

22.  Omo-Hyoideus. 

23.  Sterno-Cleido-Mastoideus. 

24.  Trapezius  as  seen  on  the  Neck. 

25.  Attachment  of  the  Fascia  Profunda  Colli  to  the  Clavicle. 

The  Levator  Menti  Vel  Labii  Inferioris,  being 
placed  beneath  the  depressor  labii  inferioris,  is  demon- 
strated by  turning  down  the  lower  lip  and  dissecting  away 
its  lining  membrane  on  the  side  of  the  frsenum.  It  will 
then  be  seen  to  arise  in  front  of  the  alveolar  processes  of 
the  external  incisor  and  the  canine  tooth  of  the  lower  jaw, 
and  passing  obliquely  downwards,  to  be  inserted  into  the 
lower  lip. 

It  elevates  the  lower  lip. 

The  Buccinator,  arises  from  the  root  of  the  coronoid 
process  of  the  lower  maxilla,  from  the  back  part  of  the 
upper  maxilla  near  the  pterygoid  process  of  the  sphenoid 
bone,  and  from  the  roots  of  the  alveolar  processes  of  both 
tire  upper  and  lower  maxillary  bones,  as  far  forwards  as  the 
dentes  bicuspides.  It  is  inserted  into  the  corner  of  the 
mouth,  and  into  the  contiguous  parts  of  the  upper  and  lower 
lip. 

It  draws  the  corners  of  the  mouth  directly  backwards. 

The  Orbicularis  Oris,  is  a circular  muscle  just  beneath 
the  skin,  much  blended  with  adipose  matter  externally,  but 
more  plain  on  the  surface  contiguous  to  the  lining  membrane 
of  the  mouth.  It  constitutes  a considerable  part  of  the 
thickness  of  the  lips,  and  surrounds  the  mouth  entirely.  It 
has  no  bony  origin,  but  arises  from  the  fibres  of  the  several 
muscles  which  join  each  other  at  the  corner  of  the  mouth, 
and  therefore,  consists  of  two  semicircular  planes,  one  for 
the  upper,  and  the  other  for  the  lower  lip. 

It  is  the  antagonist  of  most  of  the  other  muscles  of  the 
mouth.  From  its  superior  part,  a pyramidal  slip  goes  to 
the  tip  of  the  nose,  called  by  Albinus,  Nasalis  Labii  Supe- 
rioris. 

The  Masseter  is  placed  immediately  between  the  skin 
and  ramus  of  the  lower  jaw.  It  arises  tendinous  and 


MUSCLES  AND  FASCIiE. 


77 


fleshy  from  the  malar  process  of  the  upper  maxilla,  and 
from  the  inferior  edge  of  the  malar  bone  between  the  max- 
illary and  zygomatic  sutures ; and  from  the  zygomatic  pro- 
cess of  the  temporal  bone.  The  masseter  covers  all  the 
exterior  surface  of  the  ramus  of  the  lower  jaw,  as  low  down 
as  its  base.  It  is  divided  into  two  portions,  which  lie  one 
beneath  the  other ; the  internal  is  the  smaller,  and  is  insert- 
ed tendinous,  into  the  outer  part  of  the  root  of  the  coronoid 
process.  The  external,  extends  from  the  malar  bone  to  the 
angle  of  the  inferior  maxilla,  where  it  is  inserted  tendinous 
and  fleshy.  A part  of  the  internal  portion  may  be  seen  at 
the  zygomatic  suture  behind  the  external,  without  the  latter 
being  raised  up. 

When  both  portions  act  together,  they  close  the  jaws ; 
the  external  alone  also  draws  the  lower  jaw  forwards ; and 
the  internal  alone,  will  draw  it  backwards. 

The  Temporalis  muscle  lies  on  the  side  of  the  head,  oc- 
cupying its  middle  inferior  region ; it  is  covered  externally 
by  a thick  dense  tendinous  membrane,  the  fascia  temporalis, 
which  arises  from  the  semicircular  ridge  on  the  side  of  the 
cranium,  and  is  inserted  into  the  upper  margin  of  the  zy- 
goma. By  removing  this  fascia,  the  temporal  muscle  is 
seen  to  arise  fleshy  from  its  inner  surface,  from  the  whole 
length  of  the  semicircular  ridge  on  the  side  of  the  os  frontis 
and  parietale,  also  from  the  surface  of  the  cranium  between 
this  ridge  and  the  zygoma,  including  the  part  contributed 
by  the  frontal  bone,  the  lower  part  of  the  parietal,  the  squa- 
mous portion  of  the  temporal  and  the  sphenoid.  It  also 
receives  a small  accession  of  fleshy  fibres,  from  the  internal 
face  of  the  zygoma.  From  this  extensive  origin  the  fibres 
converge  towards  the  zygoma,  and  are  inserted  tendinous 
into  the  coronoid  process  of  the  lower  jaw,  surrounding  it 
on  every  side ; some  of  these  tendinous  fibres  in  front,  go 
down  nearly  as  low  as  the  last  dens  molaris. 

It  pulls  the  lower  jaw  directly  upwards. 

This  is  a proper  place  also,  for  looking  at  the  Pterygoid 
muscles  ; they  are,  however  but  imperfectly  seen.  The  only 
way  to  get  a very  good  view  of  them  is  to  make  the  dis- 
section on  a vertical  section  of  the  head,  or  on  a head  de- 
tached from  the  cervical  vertebras,  which  can  be  done  very 


78 


OF  THE  HEAD  AND  NECK. 


conveniently  when  we  are  engaged  in  the  study  of  the  nose, 
or  of  the  pharynx. 

The  Pterygoideus  Externus,  so  called  from  its  posi- 
tion, arises  fleshy  from  the  outer  side  of  the  external  ptery- 
goid process  of  the  sphenoid  bone,  from  the  under  surface 
of  the  temporal  and  spinous  process  of  the  same  bone,  and 
from  the  tuber  of  the  upper  maxilla.  It  passes  outwards 
and  backwards  horizontally,  and  is  inserted  into  the  inner 
side  of  the  neck  of  the  inferior  maxilla  and  into  the  capsu- 
lar ligament  of  the  articulation. 

When  the  muscles  of  the  opposite  sides  act  together, 
they  draw  the  lower  jaw  forwards,  but  if  alternately,  they 
give  it  a grinding  motion. 

The  Pterygoideus  Internus,  arises  by  tendinous  and 
fleshy  fibres  from  the  internal  pterygoid  process  of  the 
sphenoid  bone,  along  the  outer  side  of  the  Eustachian 
tube,  and  from  the  greater  part  of  the  pterygoid  fossa. 
Passing  downwards  and  backwards,  it  is  inserted  tendinous 
and  fleshy  into  the  interior  face  of  the  angle  of  the  lower 
jaw. 

When  the  muscles  of  the  opposite  sides  act  they  close 
the  jaw. 


Fig.  16. 


A View  of  the  Ptervgoid  Mus- 
cles, AS  SHOWN  BV  THE  REMO- 
VAL of  the  Zygomatic  Arch 

AND  THE  GREATER  PART  OF  THE 

Ramus  of  the  Jaw. 

1.  Sphenoidal  portion  of  the  Ex- 

ternal Pterygoid. 

2.  Pterygoid  portion  of  the  Ex- 

ternal Pterygoid. 

3.  Internal  Pterygoid. 


OF  THE  MUSCLES  OF  THE  NECK. 

The  dissection  of  this  part  can  now  be  advantageously 
pursued ; with  which  view,  make  one  incision  through  the 


MUSCLES  AND  FASCIAL 


79 


skin,  along  the  clavicle  and  upper  edge  of  the  sternum, 
another  from  the  chin,  over  the  thyroid  cartilage  to  the  ster- 
num, and  a third  from  the  chin  to  the  upper  part  of  the  ear. 
The  flap  thus  marked  out  is  to  be  raised  carefully,  without 
cutting  up  a superficial  membrane  that  lies  below  the  skin 
called  Fascia  Superficialis  Colli. 

The  Fascia  Superficialis  Cervicis  or  Colli,  is  a conti- 
nuation of  the  one  spread  in  front  of  the  abdominal  muscles, 
and  which  is  there  called  Fascia  Superficialis  Abdominis;  it 
passes  from  them  to  the  thorax  and  afterwards  to  the  neck. 
Its  connexion  with  the  clavicle  and  sternum  is  not  very  strong, 
and  it  goes  from  them  over  the  neck  to  the  face,  being 
slightly  fastened  to  the  base  of  the  lower  jaw  in  advance  of 
the  masseter  muscle.  It  is  spread  over  the  submaxillary 
and  parotid  glands,  is  fixed  to  the  mastoid  process,  to  the 
meatus  auditorius,  and  to  the  zygoma ; in  the  latter  place  it 
is  continuous  in  some  measure  with  the  fascia  temporalis. 
The  existence  of  this  membrane,  is  thought  by  Mr.  Colles 
of  Dublin,  to  obscure  the  affections  of  the  neck  and  of  the 
parotid  gland,  by  checking  the  development  cf  tumours, 
rendering  their  fluctuation  and  particular  feel  very  equivo- 
cal, and  giving  a wrong  course  to  the  pus  when  they  suppu- 
rate. The  fascia  superficialis  is  better  marked  over  the 
parotid  gland,  and  about  the  base  of  the  jaw,  than  lower 
down. 

The  Platysma-Myodes  or  the  Musculus  Cutaneus, 
is  immediately  beneath  the  fascia  superficialis,  or  rather  is 
between  two  laminae  of  it,  the  thicker  one  being  the  inner- 
most. It  covers  a very  considerable  portion  of  the  side 
of  the  neck,  and  extends  from  the  thorax  obliquely  to  the 
face. 

It  arises  from  the  condensed  cellular  membrane  on  the 
upper  part  of  the  pectoralis  major  muscle  and  the  deltoid 
just  below  the  clavicle,  and  nearly  the  whole  length  of  this 
bone.  Its  fibres  are  much  more  pale  than  those  of  other 
voluntary  muscles,  are  collected  into  longitudinal  fasciculi 
constituting  a plane  of  scarcely  a line  in  thickness,  and  ter- 
minate in  the  integuments  of  the  lower  jaw  and  cheek.  It 
is  slightly  attached  to  the  lower  jaw,  and  not  unfrequently 
runs  into  the  muscles  of  the  lower  part  of  the  face. 


80 


OF  THE  HEAD  AND  NECK. 


A Side  View  of  the  Superficial  Layer  of  Muscles  on  the 
Face  and  Neck. 

Fig.  17. 


1.  Tendon  of  the  Occipito-Fron- 

talis. 

2.  Its  Frontal  Belly. 

3.  Anterior  Auricul©. 

4.  Attollens  Auricul©. 

5.  Occipital  Belly  of  the  Oecipito- 

Frontalis. 

6.  Retrahens  Auricul©. 

7.  Orbicularis  Palpebrarum. 

8.8.  Levator  Labii  Superioris  Al©- 
que  Nasi. 

9.  Compressor  Naris. 


10.  Levator  Anguli  Oris. 

11.  Buccinator. 

12.  Zygomaticus  Minor. 

13.  Orbicularis  Oris  and  Zygoma- 

ticus Major. 

14.  Platysma-Myodes. 

15.  Splenius. 

16.  ’Masscter. 

17.  Sterno-Cleido-Mastoid. 

18.  Levator  Sea  pul® 

19.  Scalenus  Medius. 

20.  Trapezius. 


When  the  whole  muscle  is  in  action,  it  elevates  the  skin 
of  the  neck.  The  external  jugular  vein  is  seen  nearly  in 
the  centre  of  it,  in  the  same  direction  with  the  fibres  of  the 
muscle,  between  it  and  the  sterno-mastoid.  Upon  the  up- 


MUSCLES  AND  FASCIJE. 


81 


per  part  of  this  muscle  there  is  occasionally  a thin  distinct 
plane  of  fibres  crossing  it  and  running  into  the  depressor 
anguli  oris.  This  is  the  Musculus  Risorius  of  Santorini. 

The  Sterno-Cleido-Mastoideus  is  beneath  and  decus- 
sates the  last  muscle.  It  forms  always  a prominent  feature 
in  the  outline  of  the  neck,  by  passing  obliquely  from  the 
upper  front  part  of  the  thorax  to  the  base  of  the  cranium. 

It  arises  tendinous  and  fleshy  from  the  edge  of  the  upper 
part  of  the  sternum,  and  fleshy  from  the  sternal  end  of  the 
clavicle.  These  origins  are  separated  by  a considerable 
fissure  ; they  soon  unite  and  are  inserted  tendinous  into  the 
mastoid  process,  and  into  the  part  of  the  superior  transverse 
ridge  of  the  cranium  next  to  it. 

It  draws  the  chin  towards  the  sternum.  This  muscle  is 
to  be  detached  from  its  origin,  and  allowed  to  hang  aside 
by  its  insertion,  in  order  to  get  at  the  parts  beneath.  We 
shall  then  see,  two  narrow,  handsome,  riband-like  muscles 
on  each  side  of  the  middle  line  of  the  trachea ; they  are 
the  sterno-hyoideus  and  sterno-thyroideus.  But  before  we 
go  to  the  dissection  of  them,  it  is  necessary  to  look  at  ano- 
ther fascia  of  the  neck ; the 

Fascia  Profunda  Colli , or  Cervicis.  When  the  origin  of 
the  sterno-cleido-mastoideus  is  turned  to  one  side,  the  Fas- 
cia Profunda  of  the  neck  is  brought  into  view.  This  mem- 
brane arises  from  the  larynx,  forms  a thin  capsule  to  the 
thyroid  gland,  and  being  closely  attached  to  its  inferior  mar- 
gin, it  descends  by  investing  the  sterno-hyoid  and  thyroid 
muscles,  being  well  marked  on  their  anterior  surfaces.  It 
is  firmly  fastened  to  the  upper  edge  of  the  sternum,  the 
sternal  end  of  the  clavicles,  and  to  the  cartilages  of  the  first 
ribs,  forming  an  elastic  and  resisting  membrane  from  the 
larynx  to  the  thorax.  By  turning  off  the  sterno-hyoid  and 
thyroid  muscles  from  their  attachment  to  the  sternum,  the 
fascia  profunda,  will  be  seen  still  more  distinctly,  passing 
behind  them,  from  the  inferior  margin  of  the  thyroid  gland 
to  the  upper  bone  of  the  sternum  ; this  lamina  of  it  is  in- 
serted into  the  sternum  twelve  or  fifteen  lines  below  its  up- 
per edge.  It  encloses,  or  surrounds,  the  transverse  vein 
and  the  arteria  innominata. 

6 


82 


OF  THE  HEAD  AND  NECK. 


A Transverse  Section  of  the  Neck,  showing  the  Fascia  Pro- 
funda, and  its  Prolongations  as  Sheaths  for  the  Muscles. 


Fig.  18. 


14.  Blood-vessels  and  Pncumogas- 
tric  Nerve  in  their  Sheath. 

15.  Longus  Colli. 

16.  Rectus  Antieus  Major. 

17.  Scalenus  Antieus. 

18.  Scalenus  Medius  and  Posticus. 

19.  Splenius  Capitis. 

20.  Splenius  Colli. 


1.  Platysma  Myodes. 

2.  Trapezius. 

3.  Ligamentum  Nuchas. 

4.  Sheath  of  Sterno-Cleido- 
Mastoid. 

5.  Muscle  itself. 

6.  Point  of  Union  of  its  Fas- 
cia. 

7.  Point  of  Union  of  the  Fas- 
cia Profunda  Colli  of  each 
side  of  the  Neck. 

8.  Section  of  the  Sterno-Hy- 
oid  Muscle. 

9.  Section  of  the  Omo-Hyoid 
Muscle. 

10.  Section  of  the  Sterno-Thy. 
roid  Muscle. 

11.  Lateral  Lobe  of  the  Thy- 
roid Gland. 

12.  Trachea. 

13.  (Esophagus. 

21.  Levator  Scapula. 

22.  Complexus. 

23.  Tracbelo-Mastoid, 

24.  Transversalis  Cervicis. 

25.  Cervicalis  Descendens. 

26.  Semi-spinalis  Cervicis. 

27.  Multifidus  Spinas. 

28.  A Cervical  Vertebra. 


Beneath  the  fascia  profunda,  are  the  trachea,  the  roots  of 
the  arteries  of  the  head  and  upper  extremities,  and  the 
trunks  of  their  veins.  There  is  much  loose  cellular  and  adi- 
pose matter  placed  at  the  lower  part  of  the  neck  beneath 
this  fascia,  between  it  and  the  trachea,  and  through  which 
the  thyroid  veins  with  their  ramifications  pass.  This  last 
circumstance,  must  always  render  suppurations  and  opera- 
tions in  the  part  highly  dangerous,  as  the  pus  may  form  fis- 
tulas under  the  sternum;  moreover,  the  continual  motion  of 
the  part  in  respiration,  prevents  adhesion  from  forming,  and 
therefore  disposes  to  ulceration.  An  ingenious  idea  on 
the  uses  of  this  fascia,  and  of  the  sterno-hyoid  and  thyroid 
muscles  as  connected  with  it,  was  suggested  by  the  late 
Allan  Burns.  He  conceived  that  they  were  a defence  to 


MUSCLES  AND  FASCIJE. 


»3 

the  upper  part  of  the  thorax,  and  sustained  in  an  operation, 
the  atmospheric  pressure,  which  without  them,  would  fall 
upon  the  trachea,  and  produce  difficulty  of  breathing,  from 
the  air  not  passing  through  the  larynx  with  sufficient  rapidity 
to  keep  pace  with  the  dilatation  of  the  thorax.  He  illustrates 
this  opinion  by  a case  very  much  in  point,  of  a gentleman 
who  had  lost  this  fascia  and  the  muscles,  by  suppuration, 
and  who  was  afterwards  incommoded,  by  atmospheric  pres- 
sure upon  the  trachea  at  this  place.*  Mr.  Velpeau,  on  the 
contrary  asserts,  that  cutting  through  it  in  opening  abscesses 
and  in  operations,  has  no  such  consequences. 

The  external  borders  of  the  fascia  profunda  are  continued 
into  the  sheaths  of  the  great  vessels  of  the  neck.  It  and 
the  fascia  superficialis,  are  also  continuous  with  each  other 
along  the  anterior  edge  of  the  sterno-cleido-mastoideus. 

Within  tire  inferior  maxilla,  at  its  angle,  is  a ligamentous 
expansion  connected  with  the  pterygoideus  externus  mus- 
cle, which  is  spread  out  between  the  styloid  process  and  the 
ramus  of  the  lower  jaw.  This  membrane,  called  the  stylo- 
maxillary  ligament,  is  joined  by  the  fascia  superficialis  at  its 
inferior  edge,  just  before  the  upper  part  of  the  sterno-mas- 
toideus,  whereby  its  breadth  is  increased  downwards  in  the 
neck,  giving  it  somewhat  the  condition  of  a vertical  septum 
of  that  region  ; at  its  lower  edge  it  runs  into  the  sheath  of 
the  great  vessels  of  the  neck.  Through  its  lower  part, 
penetrate  the  stylo-hyoideus  and  digastricus  muscles,  and 
the  upper  part  separates  the  parotid  from  the  submaxillary 
gland.  It  is  felt  like  a cord,  extending  downwards  and 
backwards,  below’  the  angle  of  the  maxilla  inferior.  It  is 
connected  at  its  internal  edge  with  the  compages  of  the 
nerves  and  vessels  of  the  part,  in  such  a manner  as  to  forbid 
description,  but  the  practical  anatomist  will  find  no  difficulty 
in  discovering  and  understanding  it. 

Below  this  septum,  a round  ligament,  like  a nerve,  passes 
from  the  extremity  of  the  styloid  process,  to  the  appendix 

* The  late  Dr.  Jason  0.  B.  Lawrence,  who,  to  the  great  regret  of 
all  who  knew  him,  died  prematurely,  in  1823,  in  the  midst  of  his  la- 
bours and  usefulness  in  anatomy,  informed  me  that  this  fascia  pro- 
funda is  well  developed  in  the  neck  of  a cat;  and  that  having  occa- 
sion to  remove  it  in  an  experiment,  the  respiration  of  the  animal  was 
conducted  with  great  difficulty,  amounting  almost  to  suffocation. 
This  is  a good  confirmation  of  Mr.  Burns's  hypothesis. 


84 


OF  THE  HEAD  AND  NECK. 


of  the  os  hyoides.  Like  the  fascia  superficialis,  it  is  only  the 
sheath  for  muscles  which  it  surrounds,  and  is  called  fascia, 
from  having  some  development  of  fibrous  matter  in  its  sub- 
stance. 

A View  of  the  Superficial  and  Deep-seated  Muscles  on  the 
Front  of  the  Neck. 

Fig.  19. 


1.  Posterior  Belly  of  the  Digas- 
tricus. 

2.  Its  Anterior  Belly. 

3.  Ligamentous  Loop  on  the  Os 
Hyoides  through  which  its  Ten- 
don plays. 

4.  Stylo-Hyoideus. 

5.  Mylo-Hyoideus, 

6.  Genio-Hyoideus. 

7.  The  Tongue. 

8.  Hyo-Glossus. 

9.  Stylo.Glossus. 

10.  Stylo-Pharyngeus. 

1 1 . Sterno-Cleido-Mastoideus. 

]2.  Its  Sternal  Origin. 


13.  Its  Clavicular  Origin. 

14.  Sterno-Hyoideus. 

15.  Sterno-Thyroid  of  the  Right 
Side. 

16.  Thyro-Hyoideus. 

17.  Hyoid  Beiiy  of  the  Omo.Hyoid. 

18.  Scapular  Portion  of  the  Omo- 
Hyoid. 

19.  Anterior  Edge  of  the  Trape- 
zius. 

20.  Scalenus  Anticus  of  the  Right 
Side. 

21.  Scalenus  Posticus. 

22.  Scalenus  Medius. 


The  Sterno-Hyoideus  arises  thin  and  fleshy  on  the  inte- 
rior of  the  thorax,  from  the  approximated  surfaces  of  the 
cartilage  of  the  first  rib,  the  clavicle,  and  the  first  bone  of 
the  sternum ; it  passes  upwards,  somewhat  obliquely,  and 


MUSCLES  AND  FASCIiE 


85 


is  inserted  into  the  inferior  edge  of  the  base  of  the  os  hy- 
oides. 

It  draws  the  os  hyoides  towards  the  sternum. 

The  Sterno-Thyroideus  is  beneath  the  last,  and  con- 
cealed in  a considerable  degree  by  it.  It  arises  fleshy  from 
tire  interior  surface  of  the  sternum,  about  an  inch  below  its 
upper  margin,  and  from  the  cartilage  of  the  first  rib ; di- 
minishing in  breadth  somewhat  as  it  ascends,  it  is  inserted 
obliquely  into  the  side  of  the  thyroid  cartilage. 

It  draws  this  cartilage  towards  the  sternum. 

The  Thyro-Hyoideus,  arises  obliquely  from  the  side  of 
the  thyroid  cartilage  externally,  and  is  inserted  into  a part 
of  the  base,  and  nearly  all  the  cornu  of  the  os  hyoides.  It 
looks  like  a continuation  of  the  last. 

Use;  To  approximate  the  os  hyoides  and  the  thyroid  car- 
tilage. 

The  Omo-Hyoideus,  passes  obliquely  across  the  neck,  from 
the  superior  edge  of  the  scapula  to  the  os  hyoides.  It  is  a 
thin  narrow  muscle  divided  into  two  bellies,  one  at  each 
end,  by  an  intermediate  tendon;  its  inferior  part  is  con- 
cealed by  the  trapezius  muscle,  its  middle,  where  the  tendon 
exists,  crosses  the  great  vessels  of  the  neck  and  is  covered 
by  the  sterno-cleido-mastoid  muscle,  and  its  upper  extre- 
mity is  over-lapped  by  the  platysma-myodes. 

It  arises  from  the  scapula  just  behind  the  notch  in  its  su- 
perior costa,  and  curving  somewhat  downwards  in  its  course, 
is  inserted  into  the  lower  edge  of  the  base  of  the  os  hyoides 
next  to  its  cornu. 

It  draws  the  os  hyoides  downwards. 

The  Digastricus,  is  a double-bellied  muscle  placed  at 
the  upper  side  of  the  neck,  and  passing  from  the  back  part 
of  the  base  of  the  head  to  the  chin.  It  arises,  principally 
fleshy,  from  the  fossa  of  the  temporal  bone  at  the  inside  of 
the  mastoid  process ; as  the  muscle  descends  towards  the 
os  hyoides,  its  middle  part  is  converted  into  a round  tendon 
which  passes  through  the  stylo-hyoideus  muscle,  and  is 
fixed,  by  a ligamentous  loop,  to  the  cornu  of  the  os  hyoides. 
After  this,  the  muscle  becomes  again  fleshy  and  is  inserted 


86 


OF  THE  HEAD  AND  NECK. 


into  the  inside  of  the  base  of  the  maxilla  inferior  at  the  side 
of  the  symphysis.  It  receives  an  accession  from  the  base 
of  the  os  hyoides. 

It  draws  the  os  hyoides  upwards  when  its  extremities  are 
fixed,  and  throws  the  head  backwards  and  thereby  opens 
the  mouth,  when  the  lower  jaw  is  fixed  upon  a level  of  the 
same  height,  as  pointed  out  by  Mr.  Hunter.  By  raising  the 
posterior  belly  of  this  muscle  we  get  a better  view  of  the 
styloid  muscles,  which  are  three  in  number,  and  placed 
within  it. 

The  Stylo-Hyoideus,  is  the  more  superficial  of  the  three, 
and  arises  tendinous  from  the  middle  and  inferior  part  of 
the  styloid  process  of  the  temporal  bone,  and  being  perfo- 
rated as  mentioned,  by  the  tendon  of  the  digastricus,  is  in- 
serted tendinous  into  the  cartilaginous  juncture  of  the  base 
and  cornu  of  the  os  hyoides. 

It  draws  the  os  hyoides  upwards  and  backwards. 

The  Stylo-Glossus,  is  within  and  above  the  other;  it 
arises  from  the  upper  internal  part  of  the  styloid  process, 
tendinous  and  fleshy,  and  is  inserted  into  the  side  of  the 
root  of  the  tongue,  forming  thereby  a part  of  its  structure. 

It  drawTs  the  tongue  backwards. 

The  Styuo-Piiaryngeus  is  more  deeply  situated  than 
either  of  the  other  two  muscles.  It  arises  from  the  inner 
side  of  the  styloid  process  near  its  root,  and  runs  into  the 
inside  of  the  pharynx,  between  the  middle  and  upper  con- 
strictors, opposite  the  tonsil  gland.  It  afterwards  descends 
between  the  lining  membrane  of  the  pharynx,  and  the  mid- 
dle and  lower  constrictors,  and  is  inserted  into  the  posterior 
margin  of  the  thyroid  cartilage. 

It  draws  the  larynx  and  pharynx  upwards. 

The  Mylo-IIyoideus,  forms  the  floor  of  the  mouth  and 
suspends  the  tongue ; it  arises  from  a ridge  at  the  root  of  the 
alveolar  process  of  the  lower  jaw,  extending  from  the  last 
dens  molaris  to  the  chin.  Its  fibres  converge  inwards,  and 
are  inserted  into  the  corresponding  fibres  of  the  opposite 
side,  by  a white  tendinous  line  placed  between  it,  and  its 
fellow,  and  extending  from  the  base  of  the  os  hyoides  to  the 


MUSCLES  AND  FASCIA:. 


87 


chin.  This  muscle  lies  above,  so  as  to  be  concealed  by  the 
anterior  belly  of  the  digastricus,  and  when  it  contracts,  it 
draws  the  os  hyoides  upwards  and  projects  the  tongue. 

A Vertical  Section  of  the  Tongue  and  lower  Jaw,  showing  tiie 
Muscles  attached  thereto. 

Fig.  20. 

1.  A Section  of  the  Lower 

Jaw. 

2.  Styloid  Process  of  the  Tem- 

poral Bone. 

3.  Stylo-Glossus  Muscles. 

4.  Lower  portion  of  Genio- 

Hyo-Glossus. 

5.  Upper  portion  of Genio-Hyo- 

Glossus. 

6.  Tip  or  Point  of  the  Tongue, 

showing  the  Vertical  Lin. 
gual  Muscle. 

7.  Surface  of  the  Tongue. 

8.  Transversales  Linguae. 

9.  Superficialis  Linguae. 

10.  Superior  Extremity  of  the 

Constrictor  Pharyngis  Me- 
dius. 

11.  Stylo-Pharyngeus. 

12.  Its  Insertion. 

13.  Constrictor  Pharyngis  Inferior. 

14.  Os  Hyoides. 

15.  Thyro-Hyoid  Ligament. 

16.  Thyroid  Cartilage. 

The  Genio-Hyoideus  is  immediately  above  the  last,  by 
turning  down  the  anterior  edge  of  which,  it  is  seen.  It 
arises  tendinous  from  the  tubercle  on  the  posterior  side  of 
the  symphysis  of  the  lower  jaw,  and  increasing  somewhat 
in  breadth,  is  inserted  into  the  anterior  part  of  the  base  of 
the  os  hyoides. 

It  draws  the  os  hyoides  upwards  and  forwards.  By  re- 
moving this  muscle  we  bring  into  view 

The  Genio-Hyo-Glossus,  which  arises  also  tendinous 
from  the  tubercle  on  the  inside  of  the  maxilla  inferior,  near 
the  symphysis,  and  immediately  after  its  origin,  spreads  itself 
after  the  manner  of  a fan.  Its  inferior  fibres  are  inserted  into 
the  base  of  the  os  hyoides,  and  the  remainder  by  their  di- 
verging, are  inserted  into  the  tongue  its  whole  length,  con- 
stituting a part  of  its  substance.  The  muscles  of  the  oppo- 


OF  THE  HEAD  AND  NECK. 


site  sides  are  in  contact,  and  throw  the  tongue  into  a great 
variety  of  positions,  according  to  the  fibres  which  are  brought 
into  action. 

The  Hyo-Glossus,  is  just  on  the  exterior  of  the  last.  It 
arises  from  the  side  of  the  base  and  part  of  the  cornu  of  the 
os  hyoides,  and  from  its  appendix,  and  is  inserted  into  the 
side 
wards.' 

The  Lingualis,  may  also  be  seen  in  part  in  this  dissection. 
It  is  one  of  the  intrinsic  muscles  of  the  tongue,  and  lies  on 
tlie  inner  side  of  the  last.  For  a farther  account  of  the 
muscles  of  the  tongue,  see  the  article  Mouth. 


of  the  tongue.  It  draws  the  tongue  inwards  and  down- 


There  are  four  pairs  of  muscles  situated  on  the  front 
and  sides  of  the  cervical  vertebra,  behind  the  pharynx  and 
oesophagus,  which  can  only  be  seen  imperfectly  in  this  dis- 
section. 

1.  The  Longus  Colli,  is  next  to  the  middle  line  of  the 
vertebrae,  and  arises  from  the  sides  of  the  bodies  of  the 
three  superior  vertebrae  of  the  back,  and  from  the  anterior 
edges  of  the  transverse  processes  of  die  five  lower  cervical 
vertebrae.  Its  fibres  pass  somewhat  obliquely  upwards  and 
inwards,  to  be  inserted  into  the  front  of  the  bodies  of  all  die 
cervical  vertebrae. 

It  bends  the  neck  forwards,  and  to  one  side. 

2.  The  Rectus  Capitis  Anticus  Major,  is  placed  out- 
side the  last  muscle,  and  arises  tendinous  and  fleshy  from 
the  fronts  of  the  transverse  processes  of  die  thud,  fourth, 
fifth,  and  sixth  cervical  vertebrae,  forms  a considerable  fleshy 
belly,  and  is  inserted  into  die  cuneiform  process  of  the  os 
occipitis  just  before  the  condyle. 

It  bends  the  head  forwards. 

3.  The  Rectus  Capitis  Anticus  Minor,  is  a very  small 
muscle,  which  arises  fleshy  from  the  front  of  the  first  cer- 
vical vertebrae,  near  its  transverse  process,  and  is  inserted 


MUSCLES  AND  FASCIiE. 


89 


under  the  rectus  major  before  the  root  of  the  condyloid  pro- 
cess of  the  occipital  bone. 

It  bends  the  head  forwards. 

4.  The  Rectus  Capitis  Lateralis  is  also  small,  and 
arises  fleshy  from  the  front  of  the  transverse  process  of  the 
atlas.  It  is  inserted  tendinous  and  fleshy,  into  the  ridge  on 
the  outside  of  the  condyle  of  the  occiput,  leading  from  it  to 
the  mastoid  process. 

It  pulls  the  head  a little  to  one  side. 

On  the  outside  of  these  muscles,  passing  from  the  exte- 
rior edges  of  the  cervical  vertebrae  to  the  upper  parts  of  the 
thorax,  are  the  Scaleni  muscles,  three  in  number,  and  named 
from  their  situation. 

1.  The  Scalenus  Anticus,  arises  by  three  distinct  tendi- 
nous heads  from  the  transverse  processes  of  the  fourth,  fifth, 
and  sixth  cervical  vertebrae,  and  is  inserted  tendinous  and 
fleshy  into  the  upper  surface  of  the  first  rib,  just  anteriorly 
to  its  middle. 

2.  The  Scalenus  Medius,  arises  by  distinct  tendons  from 
the  transverse  processes  of  all  the  cervical  vertebrae,  and  is 
inserted  tendinous  and  fleshy  into  the  upper  face  of  the  first 
rib,  in  all  the  space  from  its  middle  to  its  tubercle. 

3.  The  Scalenus  Posticus,  arises  from  the  transverse 
processes  of  the  fifth  and  sixth  cervical  vertebrae,  and  is  in- 
serted into  the  upper  face  of  the  second  rib,  just  beyond  its 
tubercle. 

The  last  three  muscles  are  concealed  by  the  sterno-cleido- 
mastoideus,  and  the  anterior  edge  of  the  trapezius ; to  be 
well  seen,  the  clavicle  should  be  loosened  from  the  sternum, 
and  thrown  off  to  one  side.  The  third  Scalenus  is  best 
seen  in  dissecting  the  muscles  of  the  spine,  and  resembles 
very  much  one  of  that  class  to  which  Albinus  gives  the 
name  of  Levatores  Costarum.  All  the  Scaleni  elevate  the 
ribs  and  bend  the  neck  to  one  side.  They  are  particularly 
interesting  as  connected  with  the  course  of  the  large  blood- 
vessels and  nerves  of  the  upper  extremity,  which  will  be 
more  particularly  alluded  to  in  the  dissection  of  the  axilla. 


90 


OF  THE  HEAD  AND  NECK.. 


SECTION  III. 

Of  the  Glands  of  the  Head  and  JYeck. 

The  Thyroid  Gland,  {Gland.  Thyroidea ,)  consisting  of 
two  lobes  united  by  an  isthmus,  is  placed  on  the  first  and  se- 
cond rings  of  the  trachea  on  the  sides  of  the  larynx,  extend- 
ing upwards  laterally  by  the  cricoid  cartilage,  to  the  thy- 
roid. It  resembles  a pair  of  saddle-hags  in  its  general  out- 
line; the  upper  edge  however,  being  very  much  excavated 
or  crescentic,  with  the  horns  pointing  upwards.  The  isth- 
mus passes  over  the  second  ring  of  the  trachea,  and  is  firmly 
fixed  to  it  by  a short  cellular  substance.  Duvemey  and 
Soemmering,  in  their  plates,  represent  a muscle  passing  on 
the  left  side  of  the  larynx,  from  the  base  of  the  os  hyoides 
to  the  upper  edge  of  the  thyroid  gland,  to  which  they  give 
the  name  of  Levator  Glandulse  Thyroidese.  Its  occurrence, 
in  this  country,  is  I presume,  exceedingly  rare,  as  out  of 
several  hundred  subjects  which  I have  superintended  the 
dissection  of,  but  few  examples  of  it  have  been  noticed. 

It  may  be  observed  however,  that  a process  of  the  isth- 
mus looking  like  a muscular  slip,  is  frequently  formed  on 
the  left  side,  and  goes  up  to  the  base  of  the  os  hyoides,  and 
that  sometimes  a few  filaments  are  detached  to  the  gland 
from  the  thyreo-hyoid,  or  crico-thyroid  muscle. 

This  gland  is  covered  in  front,  by  the  sterno-hyoid  and 
thyroid,  and  laterally,  by  the  omo-hyoid  and  sterno-mastoid 
muscles.  It  is  of  a dark  brown  colour,  has  a capsule  from 
the  contiguous  cellular  membrane,  or  fascia,  besides  its  own 
proper  coat.  The  structure  of  it  is  very  imperfectly  under- 
stood ; the  most  that  we  know  is,  that  it  is  extremely  vascu- 
lar; when  cut  into,  or  inflated,  it  exhibits  a great  number 
of  cells  communicating  with  each  other,  of  different  sizes, 
and  containing  an  unctuous  and  somewhat  transparent  fluid, 
and  that  it  has  no  excretory  duct. 

The  probability  is,  that  it  is  a diverticulum  of  blood  from 
the  salivary  glands,  during  the  intermittence  of  their  action, 
and  from  the  sympathy  between  it  and  the  brain  in  goitre, 
it  may  exercise  a corresponding  function  on  this  organ 
during  its  intervals  of  repose.  On  each  side  of  the  neck  are 


MUSCLES  AND  FASCIAE. 


91 


three  large  salivary  glands,  the  Parotid,  the  Submaxillary, 
and  the  Sublingual. 

A View  of  the  Salivary  Glands  in  situ. 


Fig.  21. 


1.  The  Parotid  Gland  in  situ,  and  extending  from  the  Zygona  above,  to 

the  Angle  of  the  Jaw  below. 

2.  The  Duct  of  Steno. 

3 The  Sub-Maxillary  Gland. 

4.  Its  Duct. 

5.  The  Sub-Lingual  Gland. 

The  Parotid  Gland  ( Glandula  Parotis ) is  the  largest  of 
the  three,  and  of  a very  irregular  figure,  as  this  depends  on 
the  space  into  which  it  is  crowded.  It  reaches  from  the 
zygoma,  downwards  to  the  angle  of  the  jaw,  occupying  the 
space  from  the  mastoid  process  and  meatus  auditorius,  to 
the  ramus  of  the  jaw,  and  extending  from  the  skin  externally 
to  the  styloid  process,  styloid  muscles,  and  the  tendon  of 
the  digastricus  internally ; it  is  there  only  separated  from 
the  internal  carotid  artery  by  these  parts  internally ; its  con- 
nexions are  numerous  and  exceedingly  intricate.  It  is  re- 
moved in  the  dead  subject  from  the  contiguous  parts  with 


92 


OF  THE  HEAD  AND  NECK. 


great  difficulty,  and  in  the  living  subject,  its  complete  and 
safe  extirpation,  is  nearly  impracticable.  The  portio  dura 
nerve,  and  the  external  carotid  artery,  have  to  penetrate 
directly  through  its  substance  in  order  to  arrive  at  their 
destinations. 

It  has  been  observed,  that  this  gland  has  no  capsule,  but 
is  covered  externally,  by  an  extension  of  the  fascia  superficialis 
of  the  neck ; from  the  interior  face  of  this  fascia,  many  prolon- 
gations are  sent  off,  which  penetrate  the  gland  in  every  direc- 
tion, separating  its  lobules  from  each  other,  and  conducting 
the  blood-vessels  and  nerves  through  its  substance.  The  sub- 
stance of  the  gland  is  formed  of  small,  rounded  granulations, 
of  a light  pink  colour,  united  into  lobules  of  various  forms ; 
an  arteriole  may  be  injected,  going  to  each  of  them. 

The  parotid  gland  is  elongated  at  its  anterior  margin  into 
a point,  lying  on  the  posterior  part  of  the  masseter  muscle. 
From  the  upper  part  of  this  point,  proceeds  the  parotid  duct 
across  the  masseter  muscle,  about  eight  lines  below  the  zy- 
goma ; and  according  to  the  observations  of  the  late  Dr.  Phy- 
sick,  in  a line  from  the  under  part  of  the  lobe  of  the  ear,  to  the 
tip  of  the  nose.  The  parotid  duct,  ( Ductus  Stenonianus,) 
is  about  the  size  of  a crow  quill  and  formed  by  the  coalition 
of  branches  from  ramuscles,  which  unite  successively.  The 
gland  is  sometimes  divided  into  two  lobes,  in  which  case, 
each  has  an  excretory  duct,  that  joins  the  other,  half  an  inch 
in  front  of  the  anterior  edge  of  the  gland.  The  common 
duct  lies  close  to  the  masseter  muscle,  and  may  easily  be 
overlooked  by  the  young  anatomist ; forwards,  it  dips  over 
the  edge  of  this  muscle,  into  a fatty'  mass  between  it  and  the 
buccinator,  and,  perforating  the  latter,  has  its  orifice  in  the 
mouth,  opposite  the  second  large  molar  tooth  of  the  upper 
jaw. 

Sometimes  at  the  posterior  part  o'f  this  duct,  between  it 
and  the  zygoma,  a small  gland  is  situated,  varying  in  its 
size  and  form,  and  called  by  Haller  the  Accessory'  of  the 
Parotid. 

The  Submaxillary  Gland,  (Gland.  Sub-Maxillaris ) is 
irregularly  ovoid.  It  is  situated  below  the  Platysma-myo- 
des  in  the  space  bounded  by  the  digastric  muscle  below,  the 
mylo-hyoid  towards  the  mouth,  and  the  body'  of  the  lower 
jaw  externally,  and  is  in  contact  with  the  facial  artery.  It 


MUSCLES  AND  FASCIiE. 


93 


almost  touches  the  parotid  gland  behind,  being  separated 
from  it  only  by  the  septum  sent  in  from  the  fascia  superfi- 
cialis,  and  at  the  posterior  edge  of  the  mylo-hyoideus  it 
touches  the  sublingual  gland. 

Its  colour  and  structure  is  the  same  with  that  of  the  parotid 
gland,  except  in  the  capsule  of  cellular  membrane  with  its 
internal  prolongations,  being  much  looser.  It  has  an  ex- 
cretory duct,  ( Ductus  Whartonianus ,)  arising  in  the  same 
way  by  ramuscles,  but  much  thinner,  and  more  extensible, 
than  the  parotid  duct ; it  penetrates  between  the  back  edge 
of  the  mylo-hyoid,  and  the  hyo-glossus  muscle,  and  conti- 
nues between  the  genio-hyoglossus  and  the  sublingual  gland ; 
from  the  latter,  it  receives  occasionally  several  branches ; 
it  terminates  by  an  orifice  on  the  side  of  the  frsenum  lingjise 
near  its  anterior  edge. 

The  Sublingual  Gland  ( Glandula  Sublingualis ) is  placed 
under  the  lining  membrane  of  the  mouth,  between  the  side 
of  the  tongue,  and  the  mylo-hyoid  muscle,  and  being  ob- 
long, is  parallel  with  the  genio-hyoglossus,  wdiere  the  lat- 
ter is  about  to  join  the  tongue. 

This  gland  is  not  uniform  in  the  arrangement  of  its  ex- 
cretory ducts.  Sometimes  it  has  fifteen  or  twenty  excre- 
tory orifices  in  the  lining  membrane  of  the  mouth;  on  other 
occasions,  several  of  these  short  ducts  are  collected  into 
one  or  two  principal  trunks,  ( Ductus  Riviniani)  which  open 
either  directly  into  the  mouth,  or  into  the  duct  of  Wharton. 
By  turning  up  the  tip  of  the  tongue,  the  projection  of  this 
gland  is  readily  seen,  as  well  as  several  salivary  granula- 
lations,  or  little  glands,  which  border  on  it. 

Lymphatic  Glands.  Medical  men  are  often  consulted 
on  the  subject  of  indurated  and  not  very  painful  swellings 
in  the  neck,  which  most  frequently  are  enlarged  lymphatic 
glands.  In  a course  of  dissections  these  should  by  no 
means  be  overlooked,  as  they  are  very  numerous.  They 
vary  much  in  size  and  number,  being  for  the  most  part, 
flattened  ovals;  some  are  not  more  than  two  lines  in  their 
long  diameters,  others  are  nine  or  ten  lines  long.  They 
are  both  superficial  and  deep-seated. 


94 


OF  THE  HEAD  AND  NECK. 


Between  the  skin  and  the  insertion  of  the  sterno-mastoid 
muscle,  there  are  from  four  to  six;  in  the  interstice  just 
above  the  clavicle,  between  the  posterior  edge  of  the  sterno- 
mastoid  muscle  and  the  anterior  edge  of  the  trapezius,  bor- 
dering on  the  external  jugular  vein,  there  are  half  a dozen. 
Between  the  skin  and  the  parotid  gland  there  are  two,  one 
above,  and  the  other  below.  On  the  submaxiliary  gland, 
and  at  its  anterior  and  posterior  extremities,  there  are  eight  or 
nine.  It  is  supposed,  by  respectable  surgeons,  that  several 
asserted  cases  of  extirpation  of  the  parotid  and  of  the  sub- 
maxillary  gland,  have  amounted  actually  only  to  the  re- 
moval of  some  of  these  lymphatic  glands  in  a state  of  en- 
largement, though  these  glands  themselves  have  occasionally 
been  removed. 

The  deep-seated  lymphatic  glands,  are  also  very  abun- 
dant; along  the  course  of  the  great  cervical  vessels,  but 
principally  between  them  and  the  anterior  edge  of  the  tra- 
pezius muscle,  there  are  about  twenty.  Between  the  lower 
edge  of  the  thyroid  gland  and  the  sternum  on  the  trachea, 
there  are  four,  and  this  chain  is  continued  downwards  to- 
wards the  heart,  by  the  existence  of  several  on  the  side  of 
the  oesophagus,  trachea,  and  great  blood-vessels. 


SECTION  IV. 

Of  the  Blood-Vessels  of  the  J\'eck  and  Head. 

The  Right  Primitive  Carotid  Artery,  is  a branch  of  the 
arteria  innominata,  and  the  left,  a branch  of  the  aorta  ; their 
course  differs  somewhat  at  first,  the  right  being  more  oblique; 
afterwards  the  course  and  distribution  are  uniform  in  both. 
A regular  ascent  is  performed  in  front  of  the  cervical  ver- 
tebra), at  the  side  of  the  oesophagus  and  pharynx,  no  branch 
being  sent  otf  till  the  carotid  is  near  the  os  hyoides  and  just 
below  its  cornu.  Here  it  divides  into  two  branches,  of 
nearly  equal  size,  the  Internal  and  the  External  Carotid  ; 
the  first  is  intended  for  the  brain,  and  the  last  for  the  ex- 
ternal parts  of  the  neck  and  head.  In  the  lower  part  of 


MUSCLES  AND  FASCIAL 


95 


the  neck,  just  above  the  sternum  and  clavicle,  the  primitive 
carotid  is  covered  by  the  sterno-hyoideus  and  thyroideus,  and 
by  the  sternal  portion  of  the  sterno-cleido-mastoideus,  and 
on  a line  with  the  lower  part  of  the  thyroid  cartilage,  it  is 
crossed  obliquely  by  the  omo-hyoideus  muscle.  This  point 
may  be  ascertained  before  the  skin  is  opened,  by  a horizon- 
tal line  drawn  across  the  neck  over  the  first  ring  of  the 
trachea,  and  consequently  below  the  larynx.  In  its  whole 
course,  it  is  joined  with  the  par  vagum,  sympathetic  and 
descendens  noni  nerves. 

Parallel  with  the  larynx,  the  carotid  may  be  felt  pulsating 
very  distinctly,  being  there  covered  only  by  the  platysma 
myodes  and  integuments.  It  is  contained  in  a sheath  of 
condensed  cellular  membrane  common  to  it,  the  internal 
jugular  vein,  and  the  par  vagum  nerve. 

The  External  Carotid,  (Carotis  Externa)  at  the  place 
of  bifurcation,  is  interior  and  anterior  to  the  internal  carotid, 
and  it  immediately  begins  to  send  off  branches  in  the  fol- 
lowing order : 

1.  The  Arteria  Thyroidea  Superior,  passes  in  a me- 
andering direction  to  its  principal  destination,  the  thyroid 
gland,  through  which  it  is  minutely  distributed,  anastomosing 
freely  with  the  other  arteries  of  the  same  body.  In  its 
course  it  sends  off  the  laryngeal  branch,  which  penetrates 
to  the  muscles  of  the  larynx  between  the  os  hyoides  and 
thyroid  cartilage,  and  also  some  twigs  to  the  same  between 
the  thyroid  and  cricoid  cartilages.  It  sends  off  some  smaller 
branches  to  contiguous  parts. 

2.  The  Arteria  Lingualis  arises  just  above  the  last;  it 
goes  very  near  the  cornu  of  the  os  hyoides,  by  penetrating 
the  hyo-glossus  muscle.  At  the  root  of  the  tongue  it  sends 
off  a transverse  branch  (the  Dorsalis  Linguae,)  and  a little 
farther  forwards  it  divides  into  two  branches,  one  going  to 
the  Sublingual  Gland  (the  Ramus  Sublingualis,)  the  other 
distributed  through  the  tongue  (the  Arteria  Ranina.) 


96 


OF  THE  HEAD  AND  NECK. 


A View  of  the  Arteries  of  the  Neck  and  Shoulder. 
Fig.  22. 


1.  Primitive  Carotid  Artery. 

2.  Internal  Carotid  Artery. 

3.  External  Carotid  Arler}\ 

4.  The  Superior  Thyroid  Artery. 

5.  Branches  to  the  Muscles. 

6.  Main  Branch  to  the  Gland. 

7.  Inferior  Pharyngeal  Artery. 

8.  Lingual  Artery. 

9.  Facial  Artery. 

10.  Its  Branches  to  the  Sub-Maxillary  Gland. 

11.  Sub-Mental  Branch. 

12.  Principal  Branch  of  the  Facial  as  it  goes  over  the  jaw. 

13.  Occipital  Artery. 

14.  Branches  to  the  Muscles  on  the  back  of  the  Neck. 

15.  Main  Trunk  to  the  Occiput. 

16.  Posterior  Auricular  Artery. 


MUSCLES  AND  FASCIAE. 


97 


17.  A Branch  cut  off,  which  goes  to  the  Parotid  Gland. 

18.  Origin  of  the  Internal  Maxillary  Artery. 

19.  Origin  of  the  Temporal  Artery. 

20.  Origin  of  the  Anterior  Auricular. 

21.  The  Sub-Clavian. 

22.  Origin  of  the  Internal  Mammary. 

23.  Trunk  of  the  Inferior  Thyroid,  from  which  arise  in  this  subject 
the  Anterior  and  Posterior  Cervical  Arteries. 

24.  Branch  of  the  Inferior  Thyroid  going  to  the  Thyroid  Gland. 

25.  Anterior  Cervical  going  up  the  Neck. 

26.  Posterior  or  Transverse  Cervical. 

27.  Branches  to  the  Scaleni  and  Levator  Scapula;  Muscles. 

28.  The  Superior  Scapular  Artery. 

29.  The  Thoracica  Superior  of  the  Axillary  Artery. 

30.  A Branch  to  the  Deltoid. 

31.  Recurrent  Branches  of  the  Intercostals. 

3.  The  Arteria  Facialis  arises  near  and  above  the  other; 
it  is  tortuous,  passing  under  the  stylo-hyoid,  and  the  tendon 
of  the  digastric  muscle.  It  is  much  involved  with  the  sub- 
maxillary gland,  to  which  it  sends  branches.  The  submen- 
tal branch,  arises  from  it  here  and  passes  forwards  to  the 
symphysis  of  the  jaw,  near  the  exterior  margin  of  the  mylo- 
hyoid muscle. 

The  Arteria  Facialis  mounts  over  the  lower  jaw  just  be- 
fore the  masseter  muscle ; to  the  latter,  it  sends  a branch  ; 
forwards,  it  sends  another  towards  the  front  of  the  chin,  called 
Inferior  Labial.  On  a line  with  the  corner  of  the  mouth,  it 
sends  to  the  lips  the  Inferior  and  the  Superior  Coronary 
Arteries,  which  are  very  tortuous  and  surround  the  mouth, 
anastomosing  freely  with  those  of  the  other  side. 

After  this  the  facial  artery  ascends  to  the  internal  canthus 
of  the  eye,  sending  off  intermediately,  a branch  to  the  ala 
nasi,  and  another  which  anastomoses  with  the  infra  orbitar 
artery  ; at  the  internal  canthus  it  anastomoses  with  branches 
from  the  ophthalmic,  and  then  terminates. 

4.  The  Arteria  Pharyngea  Inferior,  is  one  of  the 
smallest  of  the  original  branches,  and  arises  from  the  carotid 
opposite  to  the  lingual ; it  is  small,  being  distributed  on  the 
pharynx,  and  sending  a branch,  the  Posterior  Meningeal  Ar- 
tery, upwards  through  the  foramen  lacerum,  to  the  dura 
mater. 

5.  The  Arteria  Occipitalis  is  large,  and  arises  opnc- 

7 


98 


OF  THE  HEAD  AND  NECK. 


site  to  the  facial  and  sometimes  higher  up.  It  crosses  over 
the  internal  jugular  vein  and  the  eighth  pair  of  nerves, 
passes  the  base  of  the  cranium  under  the  insertion  of  the 
muscles  going  to  the  mastoid  process,  and  is  distributed  to 
the  parts  lying  on  the  occipital  bone  ; its  upper  branches 
anastomose  with  those  of  the  temporal  artery. 

Its  collateral  branches,  are  one  to  the  dura  mater,  through 
the  posterior  foramen  lacerum,  or  the  mastoid  foramen, 
another  to  the  interior  parts  of  the  ear,  and  a considerable 
one  to  the  complexus  and  adjacent  muscles  of  the  neck. 

6.  The  Arteria  Posterior  Aurictjearis,  arises  from  the 
carotid  at  the  lower  edge  of  the  parotid  gland,  and  passes 
backwards  and  upwards  between  the  meatus  externus  and 
the  mastoid  process,  to  terminate  behind  the  ear.  It  is 
distributed  principally  to  the  contiguous  superficial  parts, 
but  one  branch,  goes  up  the  stylo-mastoid  foramen  (whence 
the  name  of  stylo-mastoidea,)  to  the  tympanum,  and  to  the 
labyrinth. 

The  External  Carotid,  while  detaching  these  branches, 
becomes  very  deeply  situated,  under  the  digastric  and  stylo- 
hyoid muscles  and  the  inferior  end  of  the  parotid  gland,  af- 
terwards it  penetrates  the  substance  of  the  gland,  becoming 
much  involved  in  it,  and  sending  off  several  small  twigs. 
It  ascends  through  the  gland  and  exhibits  itself  superficially 
just  before  the  meatus  externus,  in  mounting  over  the  root 
of  the  zygoma.  When  on  a line  with  the  neck  of  the  jaw- 
bone it  sends  off  a very  large  branch,  the  Internal  Maxillary, 
to  the  parts  beneath  the  ramus  of  the  bone.  The  origin  of 
this  branch,  is  to  be  considered  as  the  termination  of  the 
name  external  carotid,  and  the  trunk  is  afterwards  called 
Temporal. 

The  Arteria  Temporalis  goes  to  the  side  of  the  head; 
while  it  is  still  bedded  in  the  parotid,  it  sends  off  the 
Transversalis  Faciei,  which  crosses  the  masseter  muscle 
below  the  Parotid  Duct,  and  is  distributed  to  the  conti- 
guous parts.  The  temporal  artery  then  rises  over  the  zygo- 
ma, where  a branch  leaves  it  which  penetrates  the  tempo- 
ral fascia,  and  is  distributed  to  the  muscles  beneath  ; this  is 
the  Middle  Temporal  artery. 


MUSCLES  AND  FASCIA'S. 


99 


A View  of  the  Internal  Maxillary  Artery,  as  given  by  Sec- 
tions of  the  Bones  of  the  Head  and  Face. 

Fig.  23. 


1 . Primitive  Carotid  Artery. 

2.  External  Carotid. 

3.  Internal  Carotid. 

4.  Section  of  the  Superior  Thyroid  Artery. 

5.  Point  where  the  Facial  Artery  crosses  the  Lower  Jaw. 

6.  Inferior  Coronary  Arlerv. 

7.  Superior  Coronary  Artery. 

8.  Point  of  anastomosis  of  Facial  with  the  Nasal  Branch  of  Oph- 

thalmic. 

9.  The  Occipital  Artery. 

1 0.  Posterior  Auricular. 

11.  Temporal  Artery. 

19.  Origin  of  the  Internal  Maxillary  Artery. 

13.  Meningea  Magna  of  the  Dura  Mater  ramifying  over  its  Surface. 

14.  Inferior  Dental  Artery  in  the  Alveolar  Processes  of  the  Lower  Jaw. 

15.  'Phe  Pterygoid  Arteries. 

16.  The  Masseter  Arteries. 

17.  Deep-seated  Posterior  Temporal  Artery. 

18.  Deep-seated  Anterior  Temporal  Artery. 

19.  Buccal  Arteries. 

20.  Infra-Orbital. 

21.  Posterior  Palatine. 

22.  Origin  of  the  Pterygoid  Artery. 

23.  Origin  of  the  Spheno-Palatine. 


100 


OF  THE  HEAD  AND  NECK. 


The  temporal  artery  having  got  an  inch  or  so  above  the 
zygoma,  divides  into  an  anterior  and  a posterior  branch. 
The  first  is  distributed  forwards  on  the  temple,  inosculating 
with  its  fellow  of  the  other  side,  and  with  the  facial  and  the 
ophthalmic  artery.  The  second  is  distributed  laterally  on 
the  parietal  region,  also  anastomosing  with  its  fellow  of  the 
opposite  side,  and  with  the  occipital  artery. 

The  Arteria  Maxillaris  Interna,  can  be  got  at  only 
by  removing  the  ramus  of  the  jaw;  it  winds  around  the 
neck  of  the  inferior  maxilla,  and  proceeds  in  a very  tor- 
tuous manner  to  the  bottom  of  the  zygomatic  fossa,  touch- 
ing in  its  course,  the  inferior  surface  of  the  temporal  bone. 
It  passes  between  the  internal  and  external  pterygoid  mus- 
cles immediately  after  leaving  the  carotid  artery  ; and  sends 
off’ several  branches,  generally  in  the  following  order: 

1.  Arteria  Tympanica,  to  the  cavity  of  the  tympanum 
through  the  glenoid  fissure. 

2.  The  Arteria  Meningea  Parva,  to  the  dura  mater 
through  the  foramen  ovale. 

3.  The  Arteria  Meningea  Magna,  to  the  dura  mater 
through  the  foramen  spinale.  From  this  trunk,  sometimes 
proceeds  the  lesser  meningeal  to  the  dura  mater,  through 
the  foramen  ovale. 

4.  The  Arteria  Maxillaris,  or  Dentalis  Inferior,  to  the 
teeth  of  the  lower  jaw,  through  the  posterior  mental  fora- 
men. 

5.  The  Temporales  Profundae,  two  branches  to  the  tem- 
poral muscle;  the  first  is  the  posterior  deep,  the  second  the 
anterior  deep  temporal  artery. 

6.  The  Arteria  Pterygoidea,  branches  to  the  pterygoid 
muscles,  and  to  the  masseter. 

7.  The  Arteria  Buccalis,  a branch  to  the  buccinator  and 
zygomatieas  major. 

' S.  The  Alveolaris  or  Maxillaris  Superior  to  the  great 
and  small  molar  teeth  of  the  upper  jaw. 

9.  The  Infra-Orbitalis,  through  the  infra-orbitar  canal,  to 
the  canine  and  incisor  teeth,  and  to  the  cheek. 

10.  The  Palatina  Superior,  through  the  posterior  pala- 
tine canal  to  the  soft  palate. 


MUSCLES  AND  FASCIAL 


101 


11.  The  Pharyngea  Superior,  to  the  upper  part  of  the 
pharynx. 

12.  The  Spheno-Palatina,  which  is  the  terminating 
branch  of  the  internal  maxillary  artery,  and  is  very  mi- 
nutely distributed  to  the  Schneiderian  membrane  by  two 
trunks,  one  on  the  septum  of  the  nose,  and  the  other  on 
its  external  side. 

The  Internal  Carotid  Artery,  (Carotis  Interna)  at  its 
commencement,  is  generally  dilated  like  an  incipient  aneu- 
rism ; it  curves  much  in  getting  to  the  foramen  caroticum 
of  the  temporal  bone,  and  is  in  contact  with  the  par  vagum 
and  sympathetic  nerves;  it  sends  off  no  intermediate 
branches.  In  the  canal,  it  gives  a branch  to  the  tympanum, 
and  as  it  lies  on  the  side  of  the  sella  turcica,  it  gives  the 
anterior  and  posterior  arteries  of  the  cavernous  sinus.  Its 
subsequent  history  is  merged  in  that  of  the. ophthalmic  and 
cerebral  arteries. 

The  following  arteries  belong  to  the  neck,  and  are  derived 
from  the  Subclavian,  as  it  is  about  to  get  between  the  sca- 
leni  muscles. 

A View  of  the  Vertebral  Artery,  Carotid  and  Arch  of  the 
Aorta,  as  given  by  a Vertical  Section  of  the  Neck. 

Fig.  24. 


1.  Commencement  of  the  Tho- 

racic Aorta. 

2.  The  Innominata  at  its  Ori. 


gin. 

3.  The  Left  Sub-Clavian. 

4.  The  Internal  Mammary 

Artery. 

5.  The  Artery  of  the  Eight 

Side. 

6.  The  Inferior  Thyroid. 

7.  The  Vertebral  in  the  trans- 

verse processes  of  the 
Cervical  Vertebrae. 

8.  Superior  Inter-Costal  Ar- 

tery. 

9.  Left  Primitive  Carotid. 

10.  External  Carotid  Artery. 

11.  Superior  Thyroid. 

12.  The  Lingual,  which  has  here  a common  trunk  with  the  Facial. 

13.  Internal  Carotid. 

14.  Origin  of  the  Aorta. 


102 


OF  THE  HEAD  AND  NECK. 


1.  The  Arteria  Vertebralis,  which  goes  into  the  canal 
of  the  transverse  processes  of  the  vertebrae  of  the  neck  at 
the  sixth,  and  following  its  course,  enters  the  foramen  mag- 
num occipitis  to  be  distributed  to  the  brain.  It  is  very  tor- 
tuous at  the  first  and  second  vertebrae. 

2.  The  Arteria  Thyroidea  Inferior,  which  passes  up 
obliquely  to  the  thyroid  gland,  between  the  great  vessels  of 
the  neck  and  the  vertebrae  ; in  its  distribution  it  anastomoses 
very  freely  with  the  other  thyroid  arteries.  This  artery  ge- 
nerally sends  off 

The  Cervicalis  Anterior,  a small  artery,  which  is 
distributed  along  the  course  of  the  scaleni  muscles,  and 
which  comes  frequently  from  some  other  branch  of  the  sub- 
clavian. 

3.  The  Cervicalis  Posterior  is  very  tortuous,  and 
runs  horizontally  across  the  root  of  the  neck,  to  the  tra- 
pezius muscle  and  the  subjacent  ones.  It  arises  most 
frequently,  either  from  the  subclavian  or  the  inferior  thy- 
roid. 

The  veins  of  the  face  and  external  parts  of  the  head,  cor- 
respond so  much  with  the  distribution  of  the  arteries,  that 
they  may  be  considered  as  having  nearly  the  same  course  ; 
to  undertake  the  description  of  them,  therefore,  would  be 
almost  a repetition  of  what  has  been  said. 

Towards  the  angle  of  the  jaw  they  are  collected  into  a 
common  trunk,  the  external  jugular  (Jugularis  Externa,) 
which  crosses  obliquely  the  sterno-cleido-mastoid  muscle 
under  the  platysma-myodes,  in  the  direction  of  the  fibres  of 
the  latter,  and  runs  into  the  subclavian  vein  just  behind  the 
clavicle,  at  the  posterior  edge  of  the  sterno-cleido-mastoid 
muscle.  Sometimes  the  external  jugular  almost  immedi- 
ately after  its  formation,  joins  the  internal  jugular.  On  other 
occasions  the  facial  vein  joins  the  external  jugular ; and  the 
temporal  vein,  with  slight  accessions  from  the  side  of  the 
face,  forms  a trunk  which  descends  almost  vertically  under 
the  platysma-myodes  and  outside  of  the  sterno-cleido-mas- 
toideus,  to  join  the  subclavian  vein  in  front  of  the  scaleni 


NERVES. 


• 103 


muscles.  The  varieties,  are  in  short,  too  numerous  to  be 
recounted  in  this  work. 

The  Internal  Jugular  Vein,  (Jugularis  Interna)  may, 
with  propriety,  be  considered  as  the  great  venous  trunk  of 
the  brain,  being  a continuation  of  the  lateral  sinus.  It  lies 
on  the  outside  of  the  internal  and  of  the  common  carotid 
artery,  enclosed  in  the  same  sheath,  descends  into  the  up- 
per mediastinum  in  contact  with  the  pleura,  and  is  joined 
at  the  internal  edge  of  the  scalenus  anticus  muscle,  by  the 
subclavian  vein.  This  jugular  vein  is  occasionally  much  di- 
lated, and,  in  the  contractions  of  the  right  auricle,  spreads 
over  the  carotid  artery.  One  vein  is  sometimes  much 
larger  than  the  other. 

The  Upper  Thyroidal  Veins  discharge  into  the  internal 
or  external  jugulars;  the  Lower  Thyroidal  Veins  into  the 
transverse  or  subclavian  veins  ; sometimes  a trunk  is  formed 
across  the  upper  edge  of  the  sternum  from  one  subclavian 
to  the  other,  and  above  the  great  transverse  vein ; into  this 
the  inferior  thyroidal  veins  discharge  in  whole  or  in  part. 
The  variety  of  arrangement  is  here  also,  too  great  to  admit 
of  a standard  description. 


SECTION  V. 

Of  the  JYerves  of  the  Head  and  Neck. 

A minute  dissection  of  these  will  scarcely  be  undertaken 
by  the  young  student ; to  perform  it  successfully  requires 
much  time,  patience,  and  address;  when  by  advanced  study, 
the  latter  two  are  obtained,  the  labour  will  be  fully  compen- 
sated, by  the  pleasure  and  information  it  affords.  For  a 
very  minute  dissection  a lean  subject  is  indispensable  ; for 
a common  one,  it  is  less  important,  and  much  of  this  dissec- 
tion may  be  performed  on  the  subject  appropriated  to  the 
arteries. 


104 


OF  THE  HEAD  AND  NECK. 


A View  of  the  Facial  Nerve,  together  with  the  Branches  of 
the  Cervical  Plexus,  &c. 

Fig.  25. 


1.  The  Portio  Dura  or  Facial  Nerve  escaping  from  the  Stylo-Mastoid 

Foramen.  The  Parotid  Gland  has  been  removed  in  order  to 
show  the  Nerve  more  clearly. 

2.  Its  Posterior  Auricular  Branch. 

3.  The  Stylo-Hyoid  Branch. 

4.  The  Pes  Anserinus. 

5.  Temporal  Branches  of  the  Facial  Nerve. 

6.  Malar  Branches. 

7.  Cervico-Facial  Branches. 

8.  Supra-Orbital  Nerve. 

9.  Sub-Cutaneus-Malce,  a Branch  of  the  Superior  Maxillary  Nerve. 

10.  The  Infra -Orbital  Nerve. 

11.  Terminal  Branches  of  the  Inferior  Dental  Nerve. 

12.  Nervus  Auricularis  of  the  Cervical  Plexus. 

13.  The  Superficialis  Colli  Nerve. 

14.  The  Plexus  formed  between  the  Superficialis  Colli  and  the  branches 

of  the  Facial. 

15  The  Occipalis  Minor  Branch,  of  the  Cervical  Plexus. 

16.  Descending  branches  of  the  Cervical  Plexus. 

17.  The  Phrenic  Nerve. 

18.  The  Nervus  Accessorius  of  the  Eighth  Pair. 

19.  The  Great  or  Posterior  Occipital  Nerve. 


NERVES. 


105 


The  Portio  Dura,  comes  out  at  the  stylo -mastoid  fora- 
men, is  almost  immediately  afterwards  deeply  involved  in 
the  parotid  gland,  and  divides  into  fasciculi  in  its  substance. 
Emerging  at  different  points,  it  is  distributed  very  minutely 
on  the  side  of  the  face,  sending  branches  to  the  temple 
which  join  those  of  the  supra-orbitar  nerve,  branches  to  the 
cheek  which  join  those  of  the  infra-orb itar  nerve,  branches 
to  the  chin  which  join  those  of  the  inferior  maxillary  nerve, 
and  branches  to  the  upper  part  of  the  neck,  which  join  those 
of  the  superior  cervical  nerves. 

The  distribution  of  this  nerve,  is  too  minute  to  admit  of 
more  than  a general  reference  to  it.  Its  branches  join  each 
other  frequently,  forming  the  net-work  called  Pes  Anserinus. 
The  dissection  of  it  should  be  commenced  at  the  stylo-mas- 
toid foramen,  or  in  the  parotid  gland,  and  the  skin  should 
be  raised  only  as  its  branches  are  exposed;  without  this 
precaution  the  dissection  will  fail. 

The  Trigeminus,  or  Fifth  Pair  of  nerves,  comes  next. 
Its  branches  are  brought  into  view  by  sawing  off  the  ramus 
of  the  lower  jaw  and  detaching  it  entirely,  observing  to 
leave  the  pterygoid  muscles  by  cutting  close  to  the  bone, 
through  their  insertions ; when  the  adipose  and  cellular 
membrane  is  then  cleared  away,  the  second  and  third 
branches  of  this  nerve  are  seen  deep  in  the  bottom  of  the 
zygomatic  fossa.  For  the  distribution  of  the  first  or  oph- 
thalmic trunk,  see  the  “ Auxiliary  Parts  of  the  Eye.” 

The  Second,  or  Superior  Maxillary  branch  of  the  Fifth 
pair,  comes  out  of  the  cranium  through  the  foramen  rotun- 
dum,  and  is  first  seen  in  the  upper  part  of  the  pterygoid 
fossa.  It  immediately  sends  forwards  a branch  into  the  in- 
fra-orbitar  canal  of  the  upper  jaw  bone,  which  passes 
through  it,  comes  out  at  the  infra-orbitar  foramen,  and  ter- 
minates by  branches  on  the  face.  This  is  the  infra-orbitar 
nerve,  which  just  before  entering  the  canal,  sends  off  the 
Posterior  Dental  Nerve  to  supply  the  last  three  molares, 
and  afterwards  sends  off  the  Anterior  Dental  Nerve  to  sup- 
ply the  canine,  and  incisor  teeth.  The  Bicuspid  teeth  are 
supplied  by  a union  of  filaments  from  the  anterior  and  pos- 
terior dental  nerves. 


106 


OF  THE  HEAD  AND  NECK. 


A View  of  the  Distribution  of  the  Trigeminus  or  Fifth  Pair. 
Fig.  26. 

] . Orbit  of  eve. 

2.  Antrutn  Highmorianum. 

3.  Tongue. 

4.  Lower  Jaw-Bone. 

5.  Root  of  the  Fifth  Pair, 
forming  the  Ganglion 
of  Gasser. 

6.  First  Branch  of  the  Fifth 
Pair,  or  Ophthalmic. 

7.  Second  Branch  of  the 
Fifth  Pair,  or  Superior 
Maxillary. 

8.  Third  Branch  oft!  e Fifth 
Pair,  or  Inferior  Max- 
illary. 

9.  Frontal  Branch,  dividing 
into  External  and  In- 
ternal Frontal  Nerves. 

10.  Lachrymal  Branch  of  the 
Fifth  Pair. 

11.  Nasal  Branch.  Just  un- 
der the  Figure  is  the 
long  Root  of  the  Len- 
ticular or  Ciliary  Gan- 
glion and  a few  of  the 
Ciliary  Nerves. 

12.  Internal  Nasal  Nerve,  disappearing  through  the  Anterior  Ethmoidal 

Foramen. 

13.  External  Nasal  Nerve. 

14.  External  and  Internal  Frontal  Nerve. 

15.  Infra-Orbitary  Nerve. 

3 6.  Posterior  Dental  Branches. 

17.  Middle  Dental  Branch. 

18.  Anterior  Dental  Nerve. 

19.  Terminating  Branches  of  the  Infra-Orbital  Nerve,  called  the  Labial 

and  Palpebral  Nerves. 

20.  Subcutaneous-Mala?,  or  Orbitar  Branch. 

21.  Pterygoid  or  Recurrent  Nerve,  from  Meckel’s  Ganglion. 

22.  Five  Anterior  Brandies  of  the  Third  Branch  of  the  Fifth  Pair. 

23.  Lingual  Branch  of  the  Fifth,  joined  by  the  Chorda  Tympani. 

24.  Inferior  Dental  Nerve. 

25.  Its  Mental  Branches. 

26.  Superficial  Temporal  Nerve. 

27.  Auricular  Branches. 

28.  Mylo-Hyoid  Branch. 


Afterwards,  the  Superior  Maxillary  Nerve  passes  down- 
wards in  two  divisions,  sometimes  to  a level  with  the  sphe- 


NERVES. 


107 


no-palatine  foramen,  and  forms  the  spheno-palatine  ganglion, 
or  ganglion  of  Meckel,  from  which  proceed  the  Pterygoid, 
the  Lateral  Nasal,  and  the  Palatine  Nerves. 

The  Pterygoid  Nerve,  retrograding  through  the  foramen 
of  the  same  name,  gets  into  the  cavity  of  the  cranium  through 
the  anterior  foramen  lacerum  at  the  point  of  the  petrous  por- 
tion of  the  temporal  bone,  and  there  divides ; one  branch 
joins  the  carotid  artery,  (see  Sympathetic  Nerve,)  and  the 
other  passing  into  the  vidian  foramen,  has  a singular  course 
through  the  ear,  (see  Chorda  Tympani.) 

The  Lateral  Nasal  Nerve,  consists  of  several  filaments 
from  the  spheno-palatine  ganglion ; getting  into  the  nose, 
they  are  distributed  to  the  pituitary  membrane  of  the  outer- 
side  of  the  nose,  and  also  to  the  same  membrane  where  it 
covers  the  septum.  One  of  the  branches  of  the  latter  makes 
a long  sweep,  dips  into  the  foramen  incisivum,  and,  ac- 
cording to  Mr.  J.  Cloquet,  forms  a ganglion  with  its  fellow 
near  the  bottom  of  the  canal.  With  this  ganglion  commu- 
nicate branches  of  the  palatine  nerve. 

The  Palatine  Nerve,  passes  through  the  posterior  pala- 
tine canal  to  the  roof  of  the  mouth;  it  there  divides  into  fila- 
ments supplying  the  lining  membrane,  the  soft  palate,  the 
uvula,  and  the  tonsils.  In  its  way  downwards,  it  sends 
several  small  twigs  to  that  portion  of  the  pituitary  mem- 
brane which  covers  the  inferior  turbinated  bone. 

The  Inferior  Maxillary  Nerve,  or  the  Third  Branch 
of  the  Fifth  Pair,  comes  through  the  foramen  ovale  into  the 
zygomatic  fossa,  and  divides  immediately  into  two  branches, 
one  of  which  is  distributed  in  minute  ramifications  to  the 
muscles  of  mastication,  as  the  pterygoid,  masseter,  and  tem- 
poral; it  also  sends  a branch  (the  Superficial  Temporal,)  of 
the  size  of  a knitting-needle,  which  joins  the  portio  dura,  and 
in  orderto  get  to  it,  adheres  closely  to  the  neck  of  the  infe- 
rior maxilla.  This  last  branch  from  being  blended  with 
the  portio  dura,  must  of  course,  as  long  as  it  remains  undi- 
vided, render  nugatory  the  section  of  the  portio  dura  for 
tic  doloureux. 

The  Second  Branch  of  the  Inferior  Maxillary  Nerve, 


108 


OF  THE  HEAD  AND  NECK. 


passes  between  the  pterygoid  muscles,  and  divides  into  two 
trunks ; one  of  which  proceeding  to  the  tongue,  is  the  Lin- 
gual or  Gustatory  nerve,  and  the  other  going  to  the  lower 
jaw  bone,  is  the  proper  Inferior  Maxillary  Nerve.  The  first, 
in  its  progress  between  the  pterygoid  muscles  is  joined  by 
the  chorda  tympani ; it  then  passes  above  the  mylo-hyoid 
muscle  near  the  duct  of  Wharton,  and  advancing  to  near 
the  end  of  the  tongue,  is  divided  very  minutely  among  the 
papillse.  The  inferior  maxillary  nerve  enters  the  posterior 
maxillary  foramen  ; but  while  doing  so  despatches  a branch, 
the  Mylo-hyoid,  to  the  submaxillary  gland  and  the  muscles 
under  the  jaw ; it  then  goes  in  a canal  in  the  spongy  part  of 
the  bone.  Very  frequently  it  divides  into  two  branches,  the 
upper  of  which  is  literally  the  dental  nerve,  and  is  spent  by 
dismissing  ramifications  to  all  the  teeth  successively.  The 
nerve  below,  however,  remains  to  come  out  at  the  anterior 
maxillary  foramen,  and  is  spent  on  the  chin. 

In  order  to  proceed  properly  in  the  dissection  of  the 
Nerves  of  the  Neck,  the  skin  must  be  carefully  raised  from 
the  sterno-cleido  mastoid-muscle,  by  which  means  we 
shall  see  the  spinal  accessory  nerve  emerging  from  the  mus- 
cle, and  after  having  given  a few  branches  to  it,  passing 
backwards,  to  be  distributed  on  the  anterior  edge  of  the 
trapezius. 

By  detaching  next,  the  sterno-mastoid  muscle  from  its 
origin  and  turning  it  aside,  tire  spinal  accessory  nerve  will 
be  seen,  coming  from  the  posterior  foramen  lacerum,  where 
it  adheres  to  the  Par  Vagum,  Glosso-Pharyngeal,  and  Ninth 
Nerve;  and  passing  obliquely  behind  the  internal  jugular 
vein,  downwards  and  backwards,  in  order  to  reach  the  ster- 
no-mastoid muscle. 

At  this  stage  of  the  dissection,  a multitude  of  nervous  fila- 
ments is  seen  upon  the  neck,  going  to  its  muscles,  integu- 
ments and  other  parts,  and  interwoven  with  its  blood-ves- 
sels. They  form  an  intricate  plexus,  derived  from  various 
combinations  of  the  eighth  and  ninth  pairs,  the  sympathetic 
and  the  proper  cervical  nerves,  the  detailed  description  of 
which  is  too  elaborate  for  a dissector’s  manual.  It  is  best, 
therefore,  for  the  attention  to  be  confined  to  leading  trunks. 


NERVES. 


109 


The  Course  and  Distribution  of  the  Hypo-Glossal,  or  Ninth 
Pair  of  Nerves.  The  deep-seated  Nerves  of  the  Neck  are 
also  seen. 

Fig.  27. 


1.  The  Hypo  Glossus  Nerve. 

2.  Branches  communicating  with  the  Gustatory  Nerve. 

3.  A Branch  to  the  origin  of  the  Hyoid  Muscles. 

4.  The  Descendens  Noni  Nerve. 

5.  The  Loop  formed  with  the  Branch  from  the  Cervical  Nerves. 

C.  Muscular  branches  to  the  Depressor  Muscles  of  the  Larynx. 

7.  A Filament  from  the  Second  Cervical  Nerve,  and 

8.  A Filament  from  the  Third  Cervical,  uniting  to  form  the  com- 

municating branch  with  the  Loop  from  the  Descendens  Nom. 

9.  The  Auricular  Nerve 

10.  The  Inferior  Dental  Nerve. 

11.  Its  Mylo-Hyoidean  Branch. 

12.  The  Gustatory  Nerve. 

13.  The  Chorda-Tympani  passing  to  the  Gustatory  Nerve. 

14.  The  Chorda-Tympani  leaving  the  Gustatory  Nerve  to  join  the 

Sub-Maxillary  Ganglion. 

15.  The  Sub-Maxillary  Ganglion. 

16.  Filaments  of  communication  with  the  Lingual  Nerve. 

17.  The  Glosso-Pharyngea]  Nerve. 

18.  The  Pneumo-Gastric  or  Par  Vagum  Nerve. 

19.  The  three  Upper  Cervical  Nerves. 

20.  The  four  Inferior  Cervical  Nerves. 


110 


OF  THE  HEAD  AND  NECK. 


21.  The  First  Dorsal  Nerve. 

22.23.  The  Brachial  Plexus. 

24.25.  The  Phrenic  Nerve. 

26.  The  Carotid  Artery. 

27.  The  Internal  Jugular  Vein. 

The  Glosso-Pharyngeus,  is  a small  nerve  coming  from 
under  the  internal  jugular  vein,  adhering  to  it  and  to  the 
other  branches  of  the  eighth  pair,  by  condensed  cellular 
membrane ; it  passes  to  the  tongue,  between  the  stylo- 
glossus and  stylo-pharyngeus  muscle,  and  on  the  outside 
of  the  internal  carotid  artery.  F ollowing  the  course  of  the 
stylo-glossus  muscle  at  its  internal  edge,  it  gets  to  the  root 
of  the  tongue,  where  it  is  distributed  on  its  side  and  mid- 
dle, and  to  the  papillse  maximse.  In  its  course,  it  sends  se- 
veral branches  to  the  muscles  of  the  pharynx,  and  to  its  in- 
ternal membrane. 

The  Ninth  Pair,  or  the  Nervus  Hypoglossus,  is  also  very 
deeply  seated,  where  it  emerges  from  the  cranium,  at  the 
anterior  condyloid  foramen.  Adhering  for  some  distance 
to  the  par  vagum,  by  condensed  cellular  membrane,  it 
abandons  the  par  vagum,  by  getting  between  the  inter- 
nal carotid  artery,  and  internal  jugular  vein,  and  crossing 
them  obliquely,  about  half  an  inch  below  the  glosso-pha- 
ryngeus  muscle.  It  descends  much  lower  in  the  neck  than 
the  glosso-pharyngeal,  forming  a large  curve  with  the  con- 
vexity downwards.  It  is  the  nearest  large  nerve  below  the 
glosso-pharyngeal,  the  order  of  descent  being,  first,  the 
lingual  branch  of  the  fifth  pair,  the  glosso-pharyngeal  se- 
cond, and  the  ninth  nerve  third. 

In  its  descent,  the  Ninth  nerve  winds  externally  around 
the  external  carotid  artery,  just  below  the  origin  of  the 
occipital  artery.  Here  it  is  below  the  posterior  belly  of 
the  digastricus,  and  the  stylo-hyoideus.  It  then  passes  for- 
wards somewhat  horizontally,  under  the  external  jugular 
vein,  towards  the  root  of  the  tongue,  where  it  is  at  the  side 
of  the  hyo-glossus  muscle,  a little  above  the  os  hyoides, 
and  crossed  externally  by  the  stylo-hyoideus  and  the  tendon 
of  the  digastricus.  it  now  ascends  on  the  inside  of  the 
mylo-hyoideus,  and  divides  abruptly  into  many  ramifications 
which  are  distributed  to  all  the  muscles  of  the  tongue,  from 
the  space  between  the  genio-hyo-glossus  and  tire  lingualis 
muscle. 


NERVES. 


Ill 


Where  the  Ninth  nerve  winds  externally  around  the  ex- 
ternal carotid,  it  dismisses  the  DesCendens  Noni.  The  lat- 
ter descends  externally  along  the  common  carotid,  con- 
nected with  its  theca,  as  far  as  midway  between  the  sternum 
and  os  hyoides ; and  unites  with  ramifications  from  the  first, 
second,  and  third  cervical  nerves,  to  form  a bow  under  the 
sterno-mastoid  muscle.  Above  this  bow*,  the  descendens 
noni  detaches  branches  to  the  upper  parts  of  the  sterno-hy- 
oid  and  thyroid  muscles,  and  from  the  bow,  branches  pro- 
ceed to  the  lower  parts  of  these  muscles. 

The  Par  Vagum,  an  important  nerve,  is  immediately 
seen  on  separating  the  common  carotid,  and  the  internal 
jugular,  from  each  other.  It  lies  in  the  sbeath  of  these  ves- 
sels, at  their  back  part  and  between  them.  Emerging  from 
the  cranium  at  the  posterior  foramen  lacerum,  it  is  some- 
what swollen,  adheres  to  the  ninth  nerve,  and  to  the  supe- 
rior cervical  ganglion  of  the  sympathetic.  It  then  'leaves 
them  after  a short  distance,  assumes  the  position  just  ex- 
pressed, and  maintains  it  down  the  neck  till  it  reaches  the 
upper  margin  of  the  thorax. 

Shortly  after  quitting  the  cranium,  it  sends  to  the  middle 
constrictor  of  the  pharynx,  the  Nervus  Pharyngeus. 

Just  below  the  pharyngeal  nerve,  the  Laryngeus  Superior 
is  sent  off,  which  descends  obliquely  under  the  Internal  Ca- 
rotid, and  divides  at  the  posterior  edge  of  the  thyreo-hyoid 
membrane,  into  an  internal  and  external  branch.  The  for- 
mer being  the  largest,  and  above,  proceeds  between  the  os 
hyoides  and  the  thyroid  cartilage  under  the  thyreo-hyoideus 
muscle,  to  the  internal  parts  of  the  larynx,  where  it  is  dis- 
tributed by  minute  ramifications  to  the  arytenoid  muscles, 
epiglottis,  and  lining  membrane.  The  external  branch,  de- 
scending, is  disposed  of  by  ramifications  to  the  pharynx, 
to  the  lower  part  of  the  larynx,  and  to  the  thyroid  gland. 

In  the  upper  part  of  the  thorax,  or  the  lower  part  of  the 
neck,  the  par  vagum  abandons  the  common  carotid,  and 
passes  before  the  subclavian  artery  on  the  right  side,  and 
before  the  aorta  on  the  left.  Immediately  after  passing  these 
vessels,  it  divides  into  an  anterior  and  a posterior  trunk ; 
the  first  is  the  continued  par  vagum,  the  second  the  recur- 
rent, or  the  Inferior  Laryngeal. 

The  Laryngeus  Inferior,  has  the  same  distribution  on  both 


112 


OF  THE  HEAD  AND  NECK. 


sides,  but  it  is  to  be  observed,  that  on  the  right,  it  winds 
around  the  subclavian  artery,  and  on  the  left,  it  winds 
around  the  arch  of  the  aorta.  The  nerve  is  then  deeply 
situated  on  the  side  of  the  trachea,  and  ascends  to  the 
larynx,  sending  branches  to  the  trachea,  the  oesophagus,  and 
the  thyroid  gland.  It  is  minutely  distributed  by  termi- 
nating ramifications  to  the  small  muscles  of  the  larynx,  and 
to  its  lining  mefnbrane.  One  of  its  branches  at  the  infe- 
rior part  of  the  larynx,  communicates  with  filaments  from 
the  laryngeus  superior. 

The  Laryngeus  Inferior,  has  branches  connecting  it  with 
the  inferior  cervical  ganglion  of  the  sympathetic,  the  car- 
diac plexus,  and  the  pulmonary  plexus  of  nerves. 

The  Nervus  Sympatheticus,  is  also  on  the  back  part 
of  the  great  vessels  of  the  neck,  close  to  the  vertebrae ; it 
is  commonly  said  to  be  in  their  sheath ; this  however  is  a 
loose,  if  not  an  inaccurate  style  of  speech,  as  by  passing  a 
knife  handle  below  the  sheath,  and  raising  it  up,  it  will  be 
seen  that  the  sympathetic  is  not  one  of  its  contents ; but, 
on  the  contrary,  that  it  is  fastened  somewhat  tightly  to  the 
longus  colli  and  the  contiguous  muscles,  by  cellular  mem- 
brane. 

The  sympathetic  nerve  arises  by  filaments  of  the  ptery- 
goid, and  the  sixth  nerve,  which  form  a net-work  in  the 
carotid  canal,  around  the  artery  ; a little  above,  or  below, 
the  termination  of  the  canal,  they  unite  by  two  principal 
trunks,  to  form  one  nerve.  This  chord  is  close  to  the  eighth 
and  ninth  nerves,  and  opposite  to  the  second  cervical  ver- 
tebra ; it  swells  out  into  the  Superior  Cervical  Ganglion, 
which  for  the  purposes  of  description,  is  sometimes  con- 
sidered as  the  first  of  the  series ; it  then  descends,  and  op- 
posite to  the  space  between  the  fifth  and  the  sixth  cervical 
vertebra,  it  forms  the  Middle  Cervical  Ganglion,  which  is 
much  smaller  and  more  irregular  than  the  first.  The  sym- 
pathetic is  traced  with  some  difficulty  from  this,  in  conse- 
quence of  numerous  branches  coining  from  it ; a trunk, 
however,  may  be  found,  as  the  continuation  of  it,  which 
passes  to  the  interval  between  the  head  of  the  first  rib,  and 
the  transverse  process  of  the  last  cervical  vertebra,  where 
another  enlargement  occurs,  denominated  Inferior  Cervical, 
or  First  Thoracic  Ganglion. 


NERVES. 


113 


The  first  Ganglion  is  increased  by  filaments  from  the  sub- 
occipital,  the  first,  second,  and  third  cervical  nerves.  The 
second  Ganglion  receives  filaments  from  the  fourth,  fifth, 
and  sixth  cervical  nerves.  The  third  Ganglion  receives  fila- 
ments from  the  sixth  and  seventh  cervical,  and  the  first  dor- 
sal nerves.  From  these  ganglions  proceed  the  cardiac  nerves. 

The  Nervus  Phrenicus  is  a small,  straight,  insulated 
nerve,  coming  principally  from  the  third  cervical,  but  also 
derived,  in  part,  by  filaments  from  the  second  and  fourth. 
It  is  found  on  the  humeral  side  of  the  great  vessels  of  the 
neck,  removed  a considerable  distance  from  them,  and  lying 
upon  the  anterior  face  of  the  scalenus  anticus  muscle.  It 
descends  into  the  thorax  between  the  subclavian  artery  and 
vein,  and  within  the  anterior  end  of  the  first  rib. 

Each  of  the  Cervical  Nerves,  including  the  sub-occipital, 
after  its  ganglion  is  formed  by  the  posterior  fasciculus  of  the 
spinal  marrow,  exists  as  a trunk,  which  is  joined  by  the  an- 
terior fasciculus  of  the  same.  This  common  trunk  gets  out 
between  tbe  transverse  processes  of  the  cervical  vertebrae, 
and  is  immediately  divided  into  an  anterior  and  a posterior 
branch.  The  posterior  branches  are  distributed  to  the  mus- 
cles and  to  the  integuments,  which  lie  on  the  posterior  part 
of  the  cervical  vertebrae,  but  the  anterior  branches  are  va- 
riously disposed  of.  The  sub-occipital,  and  the  first  three 
cervical  nerves,  have  their  anterior  branches  going  princi- 
pally to  the  muscles  which  arise  from  the  transverse  pro- 
cesses of  the  vertebrae,  and  to  the  skin  of  the  neck.  Each 
of  these  anterior  branches,  is  united  by  filaments  to  the 
nerve  above  and  below  it,  and  a sort  of  plexus  is  formed, 
which  lies  over  the  levator  scapulae  muscle.  Filaments  are 
also  sent  from  the  anterior  branches  of  the  cervical  nerves, 
which  join  with  the  spinal  accessory  nerve,  the  hypo-glos- 
sal, the  portio  dura,  the  sympathetic,  and  the  phrenic,  in 
various  ways,  which  are  too  numerous  to  be  mentioned 
here. 

The  Axillary  Plexus,  from  which  the  nerves  of  the 
upper  extremity  are  principally  derived,  arises  from  the  an- 
terior branches  of  the  four  inferior  cervical  nerves,  and  of  the 
first  dorsal.  These  branches  are  much  larger  than  the  pos- 
8 


114 


OF  THE  HEAD  AND  NECK. 


terior,  and  emerge  between  the  anterior  and  the  middle 
scaleni  muscles.  They  send  some  very  small  filaments 
to  the  lower  and  middle  cervical  ganglions  of  the  sympa- 
thetic. 


SECTION  VI. 

Of  the  Eye. 

The  hairs,  on  the  superior  edge  of  the  orbit  are  called 
Skpercilia,  and  those  on  the  edges  of  the  eyelids,  the 
Cilia. 

The  Orbicularis  Palpebrarum  muscle  being  removed,  im- 
mediately beneath  it  are  the  two  Tarsi  Cartilages,  which 
form  the  margin,  and  a considerable  part  of  the  breadth  of 
the  upper  and  of  the  lower  eyelid.  The  upper  cartilage  is 
of  a semi-oval  figure,  the  broadest  part  being  not  quite  half 
an  inch ; the  lower  cartilage  is  of  an  uniform  breadth,  not 
exceeding  in  any  part  one-fourth  of  an  inch.  Their  exter- 
nal extremities  are  united  with  each  other  and  kept  in  their 
places  by  a ligamentous  expansion.,  ( Ligamentum  palpebrale 
externum ) connecting  them  with  the  orbitar  margin  of  the 
malar  bone,  and  internally  they  are  fixed  to  the  nasal  pro- 
cess of  the  superior  maxillary  bone,  by  the  tendon  ( Liga - 
mentum  palpebrale  internum ,)  which  affords  origin,  in  part, 
to  the  orbicularis  palpebrarum.  The  edge  of  these  bodies 
is  slanting,  so  that  a groove  is  formed  posteriorly  where 
they  are  in  contact,  by  which  the  tears  are  conducted  to  the 
inner  corner  of  the  eye.  Near  the  internal  extremity  of 
each,  but  not  in  the  cartilage  itself,  is  to  be  found  in  the 
centre  of  a small  eminence,  a foramen,  the  Punctum  La- 
chrymale,  capable  of  receiving  a bristle,  and  being  the  ori- 
fice of  a canal,  the  Ductus  or  Canaliculus  Lachrymalis, 
which  conveys  the  tears  into  the  Sacculus  Lachrymalis. 

On:  the  posterior  surface  of  the  tarsi  cartilages,  are  placed 
several  white  tortuous  canals  in  contact  with  each  other, 
and  having  their  extremities  on  the  edges  of  the  eyelids ; 
they  are  the  Glands  of  Meibamius,  and  secrete  an  unctuous 
substance.  In  the  upper  lid  there  are  about  thirty,  and  in 
the  lower  about  twenty. 


THE  EYE. 


115 


At  the  internal  junction  of  the  eyelids  is  placed  the  Car- 
uncula  Lachrymalis,  a small  granulated  body,  inferior  in 
size  to  a grain  of  wheat,  and  of  a glandular  structure  for 
secreting  an  unctuous  fluid. 

The  lids  are  connected  to  the  ball  of  the  eye,  by  a delicate, 
vascular,  and  highly  sensible  membrane,  the  Tunica  Con- 
junctiva, which  is  spread  over  the  anterior  third  of  the  eye, 
not  excepting  the  cornea,  but  there  it  becomes  perfectly 
transparent.  At  the  inner  surface  of.  the  eye,  the  conjunc- 
tiva is  thrown  into  a fold,  the  Plica  Semilunaris,  corres- 
ponding with  the  membrana  nictitans  of  some  animals. 

The  Lachrymal  Ducts,  (Canaliculi  Lachrymales)  are 
under  the  skin  of  the  internal  canthus,  are  from  five  to  six 
lines  long,  and  terminate  by  separate  foramina  in  the  sac- 
culus  lachrymalis.  There  is  a sort  of  flap  of  the  internal 
membrane  of  the  sac  which  falls  over  these  orifices. 

The  Lachrymal  Sac  occupies  all  the  concavity  in  the  os 
unguis,  and  extends  from  a short  distance  above  the  tendon 
of  the  orbicularis  muscle,  to  the  cavity  of  the  nose  under 
the  anterior  part  of  the  inferior  spongy  bone,  it  is  contracted 
to  the  size  of  a small  crow-quill  at  its  nasal  extremity,  and 
there  has  the  name  of  Ductus  ad  Nasum.  A duplicature 
of  the  membrane  of  the  nose  resembling  a valve,  is  fre- 
quently found  at  the  orifice  below. 

Fig.  28. . 

A View  of  the  Shape  and 
Position  of  the  Lachrymal 
Canals. 

1.  The  Puncta  Lachrymalia  or 

opening’s  of  the  Lachrymal  I 
Canals  in  the  Lids.  \ 

2.  The  CuI-de-Sac  at  the  Orbital 1 2 3  4 * 6 

end  of  the  Canal. 

3.  The  course  of  each  Canal  to 

the  Saccus  Lachrymalis. 

4.5.  The  Saccus  Lachrymalis. 

6.  The  Lower  part  of  the  Ductus 
ad  Nasum. 


a 


116 


OF  THE  HEAD  AND  NECK.. 


The  Lachrymal  Gland  for  the  secretion  of  tears,  is  placed 
in  the  superior  and  external  part  of  the  orbit,  near  its  mar- 
gin ; it  is  about  ten-twelfths  of  an  inch  long,  and  half  an 
inch  wide,  being  flattened  so  as  to  suit  the  parts  with  which 
it  is  in  contact.  It  is  placed  on  the  outer  side  of  the  tunica 
conjunctiva,  and  sends  six  or  seven  small  ducts  through  it, 
whose  orifices  are  in  the  tunica  conjunctiva  of  the  upper 
eyelid,  near  the  external  junction  of  the  tarsi  cartilages. 
It  is  divided  into  an  anterior  and  posterior  lobe  by  a small 
ligamentous  band,  attaching  it  to  the  depression  of  the  os 
frontis. 

The  muscles  in  the  orbit  are  as  follow : 

1.  Levator  Palpebr^:  Superioris,  arises  near  the  su- 
perior margin  of  the  optic  foramen,  and  is  inserted  into  the 
upper  margin  of  the  superior  cartilage  of  the  eyelid.  Use, 
to  draw  the  lid  upwards. 

2.  Levator  Oculi,  or  Rectus  Superior,  arises  from  the 
superior  margin  of  the  optic  foramen,  and  is  inserted  into 
the  upper  part  of  the  ball  of  the  eye  near  the  cornea,  by  a 
flat  tendon.  It  turns  the  cornea  upwards. 

3.  Depressor  Oculi,  or  Rectus  Inferior,  arises  from  the 
inferior  margin  of  the  optic  foramen,  and  is  inserted  into  the 
lower  part  of  the  ball  of  the  eye  near  the  cornea.  It  draws 
the  cornea  downwards. 

4.  Adductor  Oculi,  or  Rectus  Internus,  arises  from 
the  internal  margin  of  the  optic  foramen,  and  is  inserted  into 
the  internal  part  of  the  ball  of  the  eye  near  the  cornea.  It 
draws  the  cornea  inwards. 

5.  Abductor  Oculi,  or  Rectus  Externus,  arises  from 
the  external  margin  of  the  optic  foramen,  and  is  inserted  into 
the  external  part  of  the  ball  of  the  eye.  It  turns  the  cornea 
outwards. 


THE  EYE. 


117 


A View  of  the  Muscles  of  the  Eye-Ball,  taken  from  the 
Outer  Side  of  the  Right  Orbit. 

Fig.  29. 


1.  A small  Fragment  of 

the  Sphenoid  Bone 
around  the  entrance 
of  the  Optic  Nerve 
into  the  Orbit. 

2.  The  Optic  Nerve. 

3.  The  Globe  of  the  Eye. 

4.  The  Levator  Palpebrae 

Muscle. 

5.  The  Superior  Oblique 

Muscle. 


6.  Its  Cartilaginous  Pulley. 

7.  Its  Reflected  Tendon. 

8.  The  Inferior  Oblique  Muscle ; a piece  of  its  Bony  Origin  is  broken 

off. 

9.  The  Superior  Rectus  Muscle. 

10.  The  Internal  Rectus  almost  concealed  by  the  Optic  Nerve. 

11.  Part  of  the  External  Rectus  showing  its  two  heads. 

12.  The  Extremity  of  the  External  Rectus  at  its  Insertion  : the  interme- 

diate portion  of  the  Muscle  having  been  removed. 

13.  The  Inferior  Rectus  Muscle. 

14.  The  Sclerotic  Coat. 

The  Tensor  Tarsi,  or  Muscle  of  Horner,  cannot  he  here  shown,  but 
should  be  sought  for  on  the  eyelids. 


6.  Obliquus  Superior,  arises  from  the  internal  margin 
of  the  optic  foramen,  runs  along  in  contact  with  the  orbitar 
plate  of  the  os  frontis,  passes  through  the  trochlea,  near  its 
internal  angular  process,  and  being  enclosed  in  a sheath 
sent  off  from  the  trochlea,  its  round  tendon  is  inserted 
about  half-way  between  the  cornea  and  optic  nerve  in  the 
superior  part  of  the  eyeball.  It  turns  the  eye  on  its  axis. 


7.  Obliquus  Inferior,  arises  from  the  orbitar  plate  of 
the  superior  maxillary  bone  near  the  os  unguis,  and  is  in- 
serted into  the  outer  part  of  the  eyeball,  half  way  between 
the  cornea  and  optic  nerve.  It  turns  the  eye  on  its  axis. 


8.  Tensor  Tarsi.  At  the  internal  canthus  of  the  orbit 
is  a small  muscle  belonging  to  the  internal  commissure  of 
the  eyelids. 

This  muscle  is  about  three  lines  broad  and  six  lines  long; 
it  arises  from  the  posterior  superior  surface  of  the  os  unguis 
near  its  junction  with  the  os  planum,  and  passes  forwards 


118 


OF  THE  HEAD  AND  NECK. 


and  outwards,  lying  on  the  posterior  face  of  the  lachrymal 
ducts.  As  it  approaches  the  commissure  of  the  lids,  it 
splits  into  two  parts  nearly  equal,  each  of  which  is  appro- 
priated to  a duct,  and  inserted  along  its  course  almost  to 
the  punctum  lachrymale. 

To  get  a distinct  view  of  it,  the  eyelids  must  be  sepa- 
rated from  the  eye  and  turned  over  tke  nose,  leaving  the 
tendinous  attachment  of  the  orbicularis  and  ciliaris  muscle. 
The  valvula  semilunaris  being  brought  into  sight  by  this 
process,  must  be  dissected  away,  and  also  the  fat  and  cellu- 
lar membrane  underneath  it.  The  muscle  is  now  seen,  and 
by  passing  bristles  through  the  lachrymal  ducts,  its  con- 
nexion with  them  is  rendered  evident,  at  the  same  time 
that  we  get  a good  idea  of  its  size,  origin,  and  insertion. 
While  making  this  inspection,  by  turning  the  muscle  some- 
what aside,  we  shall  be  rendered  sensible  of  another  fact, 
of  some  importance,  that  the  attachment  of  the  inner  com- 
missure of  the  eyelids  to  the  internal  canthus  of  the  orbit, 
is  imperfectly  described,  even  by  anatomists  of  much  mi- 
nuteness in  their  accounts.  It  is  attributed  exclusively  to 
the  tendon  of  the  orbicularis  muscle,  so  much  so,  that  in 
the  operation  for  fistula  lachrymalis,  we  are  strictly  enjoined 
not  to  cut  through  the  tendon,  lest  a puckering  of  the  eye- 
lids be  produced,  by  their  line  of  extension  being  de- 
stroyed. The  fact  on  the  contrary  is,  that  a ligamentous 
matter  behind  this  tendon,  passes  between  the  internal  ends 
of  the  eyelids  and  the  posterior  flat  surface  of  the  os  un- 
guis, so  that  admitting  the  tendon  of  the  orbicularis  to  be 
cut  through,  this  ligament,  assisted  by  the  little  muscle  de- 
scribed, would  prevent  the  dreaded  deformity' . The  inter- 
nal extremity  of  this  posterior  ligament,  is  at  least  half  an 
inch  from  the  insertion  of  the  orbicularis  tendon  into  the 
nasal  process,  and  it  brings  the  eyelids  into  the  curve  com- 
monly seen  at  their  junction.  The  lachrymal  ducts  are  in- 
volved in  this  posterior  ligament,  passing  along  it  into  the 
sac,  instead  of  going  along  the  edges  of  the  commissure 
just  under. the  skin,  as  commonly  described. 

The  muscle  described,  must  influence  considerably  the 
position  of  the  puncta  lachrymalia,  by  drawing  them  towards 
the  ball  of  the  eye,  and  keeping  them  in  close  contact  with 


THE  EYE. 


119 


it ; it  is,  therefore,  a very  efficient  means  for  regulating  so 
far,  the  lachrymal  passages  and  for  securing  the  course  of  the 
tears.  I am  indebted  to  the  late  Dr.  Physick,  for  a farther 
suggestion  in  regard  to  its  use,  which  appears  highly  proba- 
ble. In  cases  of  extreme  emaciation,  it  is  well  known  that 
the  adipose  matter  around  the  ball  of  the  eye,  is  more  or 
less  absorbed,  causing  the  eye  to  sink  deeper  into  the  orbit, 
and  consequently  to  retire  somewhat  from  the  lids.  The 
effect  of  this  muscle  is  to  draw  the  lids  backwards  and  to 
keep  them  applied  on  the  ball.  Again,  in  the  elevation  of 
the  upper  lid,  or  rather  the  drawing  of  it  within  the  orbit  by 
the  levator  palpebrse,  the  tendency  of  the  margin  of  the  lid 
is  to  leave  the  ball ; the  upper  part  of  the  little  muscle  obvi- 
ates this  tendency.  As  such  appears  to  be  the  actions  of 
the  part,  I must  therefore,  coincide  with  him  in  calling  it 
Tensor  Tarsi,  a name  expressive  of  its  functions. 

The  puncta  lachrymalia  have  a power  noticed  by  Piichter, 
of  projecting  themselves  beyond  the  plane  of  the  eye-lid  in 
which  they  lie,  and  have  an  equally  obvious  power  of  re- 
tracting themselves,  so  as  to  do  away  all  appearance  of  pro- 
minence. I do  not  understand  the  cause  of  the  first  motion, 
but  the  second  depends  upon  the  muscle  just  described. 

The  Ball  of  the  Eye  (Bulbus  Oculi)  is  composed  of 
several  coats  and  humours.  As  the  human  subject  can 
seldom  be  obtained  sufficiently  fresh  for  a proper  display  of 
the  structure,  it  is  recommended  to  use  the  eyes  of  sheep, 
bullocks,  or  pigs,  which  can  be  got  at  any  time.  The  eye 
is  to  be  removed  from  the  orbit,  and  cleared  of  its  fat  and 
muscles.  Anatomists  have  devised  various  means  for  fixing 
it  for  dissection;  for  my  own  part,  I have  found  a common 
saucer  with  water  enough  in  it  to  float  the  organ,  sufficient. 
The  specific  gravity  of  this  fluid  approaches  so  nearly  to  that 
of  the  eye,  that  it  affords  a very  good  support  to  its  delicate 
membranes,  and  sufficient  stability  for  most  purposes  of  ex- 
amination. 


120 


OF  THE  HEAD  AND  NECK. 


A Longitudinal  Section  of  the  Globe  of  the  Eye. 


Fig.  30. 


] . The  Sclerotic  Coat. 

2.  The  Cornea. 

3.  The  Choroid  Coat. 

4.  The  Ciliary  Ligament. 

5.  The  Ciliary  Processes, 

6.  The  Iris. 

7.  The  Pupil. 

8.  The  Retina. 

9.  The  Canal  of  Petit,  which  encircles  the  Lens. 

10.  The  Anterior  Chamber  of  the  Eye,  containing  the  Aqueous  Hu- 

mour. 

1 1 . The  Posterior  Chamber. 

12.  The  Lens  enclosed  in  its  proper  Capsule. 

13.  The  Vitreous  Humour  enclosed  in  the  Hyaloid  Membrane. 

14.  A Tabular  Sheath  of  the  Hyaloid  Membrane. 

15.  The  Neurilema  of  the  Optic  Nerve. 

16.  The  Arteria  Centralis  Retin®. 


The  Tunica  Sclerotica  the  first  coat  of  the  eye,  is  to  be 
examined  by  opening  the  ball  very  freely,  and  turning  out 
all  of  its  contents.  We  shall  then  see  that  it  has  consider- 
able thickness,  being  of  a compact  fibrous  texture,  possessed 
of  little  elasticity,  and  therefore  well  calculated  for  giving 
support  to  the  interior  structure.  It  is  white  and  tendinous 
like  the  dura  mater,  and  has  few  vessels  or  nerves.  It  is 
connected  behind,  to  the  optic  nerve,  where  it  is  perforated 
by  several  small  holes  for  the  passage  of  the  nerve  ; and  be- 
fore to  the  Cornea. 


THE  EVE. 


121 


The  Cornea  is  a perfectly  transparent  membrane,  con- 
sisting of  many  laminae,  united  by  a delicate  cellular  sub- 
stance. It  is  much  more  convex  than  the  sclerotica,  and  is 
united  to  it  by  a broad  sloping  edge,  where  the  two  mem- 
branes adhere  very  firmly  to  each  other  by  the  sclerotica 
overlapping  the  cornea.  They  may  be  separated  by  putre- 
faction. The  cornea  in  a healthy  state,  has  no  red  blood 
circulating  through  it.  It  is  covered  before  by  the  tunica 
conjunctiva,  which  there  becomesassimilated  in  its  sensible 
properties  to  it,  and  behind  by  the  capsule  of  the  aqueous 
humour. 

An  eye  being  floated  in  the  manner  just  mentioned,  a 
puncture  is  to  be  made  with  a lancet  or  sharp-pointed  scal- 
pel, through  the  sclerotica,  about  half  way  from  its  centre ; 
and  the  blunted  blade  of  a pair  of  scissors  being  introduced 
through  the  opening,  a circular  cut  should  be  made  all  around, 
taking  great  care  not  to  injure  the  coat  below.  By  making 
radiated  sections  to  the  optic  nerve  from  this  circular  one, 
we  shall  be  able  to  peel  off  with  but  little  difficulty,  all  the 
posterior  part  of  the  sclerotica,  observing  however,  to  leave 
the  optic  nerve.  What  remains  of  the  anterior  part  of  the 
sclerotica,  may  be  easily  drawn  away  along  with  the  cornea. 
This  stage  of  the  dissection  gives  a good  view  of  the  Tunica 
Choroidea;  of  a white  circle  called  the  Ciliary  Ligament, 
seeming  to  terminate  it  before,  and  of  the  Iris  placed  upon 
the  fore  part  of  the  eye,  an  opening  in  the  middle  of  which 
affords  a glimpse  of  the  internal  structure. 

The  Tunica  Choroidea  lines  all  the  interior  of  the  scle- 
rotica and  is  a much  thinner  and  more  delicate  membrane 
than  it;  it  appears  black,  and  is  covered  on  the  outside  with  a 
flocculent  cellular  substance  connecting  it  with  the  sclerotica. 
Its  black  colour  depends  upon  a large  quantity  of  colouring 
matter  deposited  principally  on  its  inner  surface,  and  called 
Pigmentum  Nigrum.  The  tunica  choroidea  abounds  with 
blood-vessels,  which  make  it  look  perfectly  red  in  living 
animals  devoid  of  the  black  pigment.  It  has  a singular  ar- 
rangement of  veins,  which  can  be  made  distinct  only  by  in- 
jection. They  are  called  Vasa-Vorticosa.  It  is  well  fur- 
nished with  nerves,  which  appear  like  flattened  pieces  of 
white  thread  lying  on  its  outside.  If  the  Iris  be  torn  away, 


122 


OF  THE  HEAD  AND  NECK. 


the  anterior  edge  of  the  membrane  is  seen  terminating  in  a 
fringe,  called  Corpus  Ciliare,  and  this  fringe  if  closely  ob- 
served, will  be  seen  to  consist  of  a great  number  of  short 
and  distinct  processes,  arising  from  small  folds,  called  the 
Ciliary  Striae,  and  covered  with  pigmentum  nigrum. 

The  Iris,  is  a membrane  placed  across  the  eye  just  behind 
the  cornea  ; it  is  highly  vascular,  but  having  a large  quantity 
of  pigmentum  nigrum  on  its  posterior  surface,  the  vessels 
are  not  evident  in  a living  state.  Its  anterior  surface  deter- 
mines the  colour  of  the  eye.  In  its  centre  is  a round  hole 
called  the  Pupil,  for  admitting  light,  and  which  is  increased 
or  diminished,  by  the  action  of  circular  and  radiated  fila- 
ments composing  the  body  of  the  membrane.  They  are  con- 
sidered by  many  as  muscular.  In  the  Fcetus  the  pupil  is 
closed  by  the  Membrana  Pupillaris  till  the  seventh  month. 

The  Ciliary  Ligament  as  stated,  is  a circle  of  whitish 
substance  which  is  placed  around  the  anterior  part  of  the 
eye,  and  serves  to  connect  strongly  the  Iris  with  the  Tunica 
Chorodea,  and  these  again  with  the  anterior  edge  of  the 
Sclerotica  and  the  margin  of  the  cornea.  In  it  is  a canal, 
called  the  Aqueduct  of  Fontana. 

Having  finished  the  examination  of  these  parts,  with  two 
pair  of  fine  forceps  strip  off  the  whole  of  the  Tunica  Cho- 
roidea.  This  is  one  of  the  nicest  manipulations  in  the  whole 
dissection,  and  must  therefore  be  done  with  great  care.  If 
it  be  well  executed,  the  most  delicate  membrane  in  the  hu- 
man frame,  will  be  found  lining  the  choroid  coat ; it  was  dis- 
covered in  Dublin,  by  Mr.  Jacobs,  and  may  be  satisfactorily 
demonstrated,  by  commencing  at  the  optic  nerve  with  the  ex- 
tremity of  a knife  handle,  and  turning  the  membrane  down, 
by  scraping  towards  the  anterior  part  of  the  eye.  It  extends 
from  the  optic  nerve  to  the  anterior  edge  of  the  retina. 

Beneath  the  Tunica  Jacobi,  is  placed  the  Retina,  a deli- 
cate, transparent,  and  pulpy  membrane,  extending  from  the 
optic  nerve,  distinctly  to  the  commencement  of  the  Ciliary' 
Striae  of  the  Choroid  Coat ; and  some  anatomists  maintain, 
that  it  goes  on  as  far  as  the  circumference  of  the  Crystalline 
Humour,  which  is  by  no  means  so  obvious.  The  optic 


/ 


THE  EYE. 


123 


nerve,  after  penetrating  the  cribriform  part  of  the  Tunica 
Sclerotica,  forms  a bulb  on  its  inside ; from  this  bulb  the 
membrane  called  Retina,  is  expanded  over  the  interior  sur- 
face of  the  eye.  The  Retina  consists  of  two  layers ; the 
internal  is  a very  delicate  and  a vascular  net-work,  consist- 
ing of  fine  meshes ; the  external  is  the  proper  nervous 
matter,  having  a consistence  not  much  stronger  than 
common  mucus.  In  the  centre  of  the  optic  nerve  is  seen 
the  artery  which  supplies  the  Retina,  called  the  Arteria 
Centralis.  The  branches  of  veins  correspond  with  the  arte- 
rial ramifications,  and  we  commonly  see  them  distended 
with  blood,  in  our  dissections  of  animals  killed  by  a blow  on 
the  head.  In  the  centre  of  the  Retina,  is  the  Foramen  of 
Soemmering,  surrounded  by  a yellow  spot,  and  having  a fold 
connecting  it  to  the  bulb  of  the  optic  nerve.  Impressions 
made  on  the  Retina  are  supposed,  generally,  to  be  the  cause 
of  vision,  and  of  the  contractions  and  dilatations  of  the  pu- 
pil. The  late  Dr.  Physick  believed,  in  regard  to  the  latter, 
that  the  Iris  was  immediately  stimulated  by  the  light,  as  he 
had  seen  cases  where  its  motions  were  active  and  well 
marked,  in  paralysis  of  the  Retina. 

The  Humours  of  the  Eye  are  three,  the  Vitreous,  Crys- 
talline, and  Aqueous.  They  are  all  perfectly  transparent, 
but  differ  much  in  their  consistence  and  structure. 

The  Vitreous  occupies  nearly  all  the  eye  posterior  to  the 
Iris  ; it  is  like  melted  glass,  from  whence  its  name.  When 
minutely  examined,  it  is  found  to  consist  of  a fluid  like 
water,  contained  in  a very  delicate  membrane  or  capsule, 
which  is  cellular ; the  peculiar  consistence  of  it  is  therefore 
derived  from  the  latter.  This  capsule,  called  Tunica  Hya- 
loidea,  is  fixed  at  the  bottom  of  the  eye  by  a branch  of  the 
central  artery  of  the  Retina,  and  before,  by  a close  adhesion 
to  the  Ciliary  Stride  and  Body.  The  Retina  lies  loose 
upon  it. 

The  Crystalline  Humour  is  fixed  on  the  anterior  part  of 
the  Vitreous  just  behind  the  pupil.  It  is  a double  convex 
lens,  about  three  and  a half  or  four  lines  in  diameter,  the  pos- 
terior convexity  of  which  is  much  the  greatest.  Its  con- 
sistence is  that  of  half  dissolved  glue,  but  it  becomes  more 


124 


OF  THE  HEAD  AND  NECK. 


solid,  towards  the  centre.  By  putting  it  in  boiling  water  for 
half  an  hour,  it  becomes  hard  and  opake,  and  one  is  enabled 
to  unravel  its  structure.  It  consists  entirely  of  concentric 
lamellae,  which  may  be  separated  with  a needle,  into  very 
fine  fibres.  It  is  enclosed  in  a capsule  of  the  same  shape, 
and  between  it  and  the  capsule  is  found  a small  quantity  of 
transparent  fluid,  called  Liquor  Morgagni.  Anatomists  do 
not  agree  in  regard  to  the  origin  of  the  capsule,  some 
thinking  that  it  is  entirely  derived  from  the  tunica  hyaloidea, 
others  that  it  is  totally  distinct  from  it,  an  opinion  which  I 
am  disposed  to  consider  tire  correct  one.  Admitting  the 
opposite  to  be  correct,  the  structure  of  the  tunica  hyaloidea 
is  unquestionably  much  altered,  especially  in  front,  as  the 
capsule  there  is  possessed  of  more  thickness,  is  elastic,  and 
cuts  very  much  like  the  thin  shavings  of  a finger  nail.  In 
the  tunica  hyaloidea,  surrounding  the  circumference  of  the 
capsule  of  the  lens,  is  placed  the  Canal  of  Petit,  which, 
when  inflated  or  injected  is  seen  to  be  divided  in  a radiated 
manner,  by  a number  of  incomplete  partitions. 

The  Aqueous  Humour  is  placed  between  the  lens  and 
the  cornea,  and  is  nearly  as  thin  as  water.  The  Iris  floating 
in  it,  has  occasioned  the  division  of  the  space  occupied  by 
the  aqueous  humour,  into  Anterior  and  Posterior  Chambers 
of  the  Eye;  all  the  space  of  tire  aqueous  humour  behind  the  Iris, 
is  called  the  Posterior  Chamber,  and  all  the  space  before  the 
Iris,  is  called  the  Anterior  Chamber.  Both  of  these  chambers 
are  said  by  Mr.  J.  Cloquet,  to  be  lined  by  the  capsule  of  tire 
aqueous  humour  ; this  membrane,  however,  is  not  very  evi- 
dent except  on  the  posterior  surface  of  the  Cornea. 

The  ball  of  the  eye,  and  the  muscles  surrounding  it,  are 
imbedded  in  a considerable  quantity  of  adipose  matter,  tire 
profusion  of  which,  in  health,  gives  prominence  to  the  or- 
gan, and  the  absorption  of  which  in  disease,  produces 
the  sunken  eye. 

OF  THE  VESSELS  AND  NERVES  MET  WITH  IN 
THE  ORBIT. 

To  display  these  parts,  the  roof  of  the  orbit  must  be 
entirely  removed.  The  internal  Carotid  Artery,  as  it  lies 


THE  EYE. 


125 


near  the  anterior  clinoid  process  of  the  sphenoid  bone,  de- 
taches a large  branch,  the  Ophthalmic,  which,  in  passing 
through  the  optic  foramen  is  first  under  the  optic  nerve,  then 
gets  to  the  outside  of  it,  and  finally  winds  over  to  the  in- 
side of  the  nerve.  Near  the  posterior  part  of  the  eye,  it  sends 
off  a branch  which  penetrates  to  the  centre  of  the  optic 
nerve,  and  is  distributed  to  the  retina.  It  also  divides  into 
several  branches  which  go  to  the  Lachrymal  gland ; to  the 
muscles  of  the  eye-ball ; to  the  Tunica  Choroidea,  consti- 
tuting the  Ciliary  Arteries ; and  finally  branches  which 
pass  through  the  anterior  and  posterior  sethmoidal  foramina 
and  through  the  superciliary  foramen.  At  the  bottom  of 
the  orbit,  and  coming  out  at  the  infra-orbitar  foramen  upon 
the  face,  is  found  a large  branch  of  the  Internal  Maxil- 
lary Artery. 

The  Veins  of  the  Orbit  have  very  much  the  same  course 
with  the  arteries,  some  being  connected  with  the  facial  vein 
at  the  internal  angle  of  the  eye,  and  passing  into  tire  exter- 
nal jugular;  others,  sending  a trunk  through  the  fora- 
men opticum,  which  runs  into  the  cavernous  sinus,  and  con- 
sequently into  the  lateral  sinuses. 

Five  trunks  of  Nerves  are  to  be  found  in  the  Orbit. 

1.  The  Optic,  which  is  expanded  into  the  Retina. 

2.  The  Third  Pair,  or  Motor  Oculi,  which,  passing 
through  the  foramen  sphenoidale  into  the  orbit,  divides  into 
two  branches.  One  goes  to  the  upper  part  of  the  orbit,  and 
is  distributed  to  the  Levator  Oculi,  and  the  Levator  Palpe- 
brae  Superioris ; the  other  goes  to  the  Adductor,  the  Depres- 
sor, and  the  Obliquus  Inferior.  From  it  is  sent  a filament 
which  runs  to  the  Lenticular  or  Ophthalmic  ganglion  ; the 
latter  is  situated  on  the  outside  of  the  optic  nerve  near  its 
entrance  into  the  orbit. 

3.  The  Trociilearis  or  Patheticus,  the  Fourth  pair  of 
nerves,  is  exclusively  appropriated  to  the  Obliquus  Superior 
muscle,  and  also  gets  into  the  orbit,  through  the  foramen 
sphenoidale. 

4.  The  Motor  Exterxus  or  Sixth  pair  of  nerves,  passes 


126 


OF  THE  HEAD  AND  NECK. 


through  the  foramen  sphenoidal  of  the  orbit,  and  is  spent 
on  the  Musculus  Abductor. 

5.  The  First  Branch  of  the  Fifth  nerve,  or  the  Ophthal- 
mic, passing  also  through  the  same  foramen,  divides  into 
the  Frontal,  Nasal,  and  Lachrymal.  The  first  has  but  lit- 
tle to  do  with  the  orbit,  as  it  simply  passes  along  its  supe- 
rior part,  to  get  out  upon  the  forehead  through  the  supra-or- 
bitar  foramen,  and  at  the  trochlea  of  the  os  frontis.  The 
second  passes  along  the  inner  side  of  the  orbit,  sends  a fil- 
ament to  the  lenticular  ganglion,  another  through  the  an- 
terior asthmoidal  foramen  which  goes  ultimately  to  the 
nose,  and  what  remains  is  distributed  to  the  lachrymal  sac 
and  the  contiguous  parts.  The  third  branch  goes  to  the 
lachrymal  gland,  whence  its  name. 


SECTION  VIL 
Of  the  Ear. 

The  organ  of  hearing,  may  for  the  purpose  of  study,  be 
divided  into  three  parts,  the  boundaries  of  which  even  by 
nature,  are  well  defined  ; to  wit,  the  External  Ear,  the 
Tympanum,  and  the  Labyrinth. 

The  External  Ear,  consists  of  the  structure  exterior  to 
the  head  ; and  of  the  passage  called  Meatus  Auditorius  Ex- 
ternus,  leading  to  the  interior  of  the  petrous  portion  of  the 
temporal  bone. 

The  part  in  common  language  called  Ear,  is  principallv 
cartilaginous,  but  to  the  lower  edge  of  the  cartilage  is  ap- 
pended a softer  structure,  consisting  of  delicate  granulated 
adeps,  with  a kind  of  tendinous  cellular  membrane.  The 
cartilaginous  portion  is  called  Pinna,  the  other  Lobus. 
The  pinna  presents  a very  unequal  surface  both  on  the  out- 
side and  on  the  inside.  The  former,  being  the  part  em- 
ployed in  collecting  rays  of  sound  and  converging  them 
through  the  meatus  externus,  merits  our  principal  attention. 


THE  EAR. 


127 


The  deep  concavity  in  the  middle  of  it,  is  called  Concha. 
In  the  upper  part  of  the  concha,  and  dividing  it  into  two 
unequal  fossae,  we  find  a ridge  of  cartilage  commencing, 
which  is  traced  in  the  form  of  a scroll,  along  the  circumfe- 
rence of  the  pinna,  till  it  terminates  insensibly  in  the  poste- 
rior part  of  the  lobus.  This  fold  is  the  Helix  ; within  it  is 
a ridge  of  cartilage,  which  is  the  Antihelix,  terminating 
above  by  a bifurcation.  On  the  anterior  part  of  the  concha 
and  overlapping  it  obliquely,  is  the  cartilaginous  process 
called  Tragus,  and  opposite  to  it  at  the  lower  end  of  the 
antihelix,  is  the  Anti-Tragus.  Under  the  fold  of  the  helix  is 
the  Cavitas  Innominata,  and  between  the  bifurcation  of  the 
antihelix  is  the  Scapha. 

Fig.  31. 

An  Anterior  View  of  tiif.  Exter- 
nal Ear,  as  well  as  of  the  Mea- 
tus Auditorius,  Labrynth,  &c. 

1.  The  Opening  into  the  Ear  at  the- 

bottom  of  the  Concha. 

2.  The  Meatus  Auditorius  Externus 

or  Cartilaginous  Canal. 

3.  The  Membrana  Tytnpani  stretched. 

upon  its  ring. 

4.  The  Malleus. 

5.  The  Stapes. 

6.  The  Labyrinth. 


The  Meatus  Auditorius  Externus,  is  in  the  adult  about 
one  inch  in  depth,  calculating  from  the  bottom  of  the  con- 
cha, to  the  membrane  of  the  tympanum ; it  proceeds  ob- 
liquely  forwards,  in  a course  corresponding  to  the  situation 
of  the  petrous  bone,  and  besides  that,  has  a curve  with  the 
convexity  upwards,  so  that  when  we  wish  to  see  the  mem- 
brana tympani,  or  look  to  the  bottom  of  the  canal,  the  ex- 
ternal ear  must  be  pulled  upwards  and  backwards.  The 
internal  half  is  bony,  but  the  outer  half  is  composed  of  car- 
tilage and  of  ligamentous  matter.  If  the  skin  be  removed 
from  the  ear,  it  will  be  seen  that  the  concha  is  formed  not 


128 


OF  THE  HEAD  AND  NECK. 


entirely  by  cartilage  ; but  at  the  bottom  of  it,  and  connect- 
ing it  and  the  commencement  of  the  helix  with  the  tragus, 
is  a ligamentous  expansion,  which  contributes  also  to  the 
meatus  externus.  In  the  tragus  cartilage,  near  the  bone, 
are  found  two  fissures  filled  up  with  elastic  ligamentous 
substance  ; they  are  the  Incisurse.  The  whole  of  this  ar- 
rangement of  cartilaginous  and  membranous  matter  is  highly 
favourable  to  the  exercise  of  the  sense,  as  the  former,  by  its 
resistance,  is  well  calculated  for  reverberating  sound,  and 
the  latter  affords  great  facility  of  motion,  as  a kind  of  hinge  is 
formed  by  the  incisurse.  The  cartilaginous  matter  is  joined 
by  ligaments  to  the  bony  meatus,  the  exterior  edge  of  the  pe- 
trous bone  being  rough  and  irregular  for  this  purpose  ; there 
are  also  three  ligaments,  one  sent  to  a point  above  the  mas- 
toid process,  one  to  the  zygomatic  process,  and  a third  to 
the  temporal  aponeurosis. 

The  External  Ear  is  covered  by  a delicate  skin,  having  a 
great  number  of  sebaceous  follicles  in  it ; as  the  skin  de- 
scends into  the  meatus,  it  becomes  still  more  delicate  and 
sensible,  is  beset  with  hairs,  and  under  it  are  found,  in  con- 
siderable numbers,  the  Glandulse  Ceruminosse,  which  secrete 
the  wax. 

On  the  external  ear  are  five  muscles,  which  can  seldom 
be  seen  distinctly  enough  to  merit  the  name.  On  the  supe- 
rior and  anterior  part  of  the  helix,  is  the  Helicis  Major:  on 
its  inferior  part  is  the  Helicis  Minor;  on  the  anterior  side  of 
the  tragus  is  the  Tragicus  ; on  the  anterior  part  of  the  anti- 
tragus is  the  Antitragicus ; and  on  tire  cranial  side  of  the 
ear  is  the  Transversus  Auris. 

In  most  persons,  there  are  also  three  muscles  appropriated 
to  the  movement  of  the  external  ear  upon  the  head,  and 
which,  though  sufficiently  well  developed,  are  scarcely  ever 
employed.  The  Attolens  Auriculas,  which  arises  by  a broad 
membrane  from  the  tendon  of  the  occipito-frontalis  and  the 
fascia  of  the  temporal  muscle,  and  is  inserted  into  the  pro- 
minence made  by  the  Scapha,  or  Fossa  Navicularis.  The 
Anterior  Auriculae,  which  arises  from  the  temporal  fascia, 
just  above  the  posterior  part  of  the  zygoma,  and  is  inserted 
into  the  anterior  part  of  the  helix.  And  the  Retrahens  Au- 
riculae, consisting  of  two  or  three  parallel  slips,  the  inferior 
of  which  arises  from  near  the  root  of  the  mastoid  process, 


THE  EAR. 


129 


and  is  inserted  into  the  prominence  made  by  the  concha  be- 
low ; while  the  second  slip,  arises  from  the  temporal  bone 
higher  up  than  the  former,  to  be  inserted  also  into  the  back 
of  the  concha  above  the  first.  The  names  of  these  muscles 
express  their  action. 

2.  THE  TYMPANUM. 

This  is  the  middle  portion  of  the  organ  of  hearing, 
and  is  situated  in  the  outer  part  of  the  Petrous  Bone, 
being  separated  from  the  Meatus  Externus  by  a partition 
called  Membrana  Tympani.  The  membrana  tympani  is 
placed  very  obliquely  just  at  the  bottom  of  the  meatus, 
its  upper  part  being  the  outermost.  It  is  not  flat,  but  has 
its  centre  drawn  inwards  by  the  handle  of  the  malleus.  It 
consists  of  four  layers,  the  cuticle,  the  true  skin,  the  proper 
membrane,  and  the  lining  membrane  of  the  tympanum. 
When  successfully  injected,  it  shows  a high  degree  of  vas- 
cularity. The  two  outer  layers  are  easily  separated  from 
the  others,  and  do  not  partake  much  of  their  vascularity. 

The  tympanum  contains  a great  deal  of  curious  and  in- 
teresting structure;  its  depth  is  about  three  lines;  its  antero- 
posterior diameter  six  lines ; and  its  vertical  diameter  rather 
more.  On  its  superior  posterior  part  is  an  oval  opening, 
communicating  with  an  extensive  cellular  arrangement  in 
the  Mastoid  Portion  of  the  temporal  bone  ; and  on  its  ante- 
rior side  is  seen  the  canal  of  Eustachius,  going  to  the  pos- 
terior naris.  In  the  bottom  and  central  part  of  the  tym- 
panum, is  a striking  convexity,  the  Promontory,  just  above 
the  superior  edge  of  which  is  the  Foramen  Ovale,  and  be- 
low and  somewhat  behind  it,  is  the  Foramen  Rotundum. 
On  the  posterior  surface  of  the  tympanum,  in  a line  with 
the  foramen  ovale,  is  a very  small  bony  process,  the  Pyra- 
mid, which  is  hollow,  and  has  a hole  in  its  apex. 

Four  small  bones  are  found  in  the  tympanum,  which  form 
a chain  between  the  membrana  tympani  and  the  Labyrinth  ; 
they  are  the  Malleus,  Incus,  Os  Orbiculare,  and  Stapes. 

The  Malleus  is  placed  before  the  others,  and  consists  of 
a spherical  head,  a neck  just  belovT  the  head,  uniting  it  wTith 
9 


130 


OF  THE  HEAD  AND  NECK. 


a tapering  handle;  a long  and  crooked  projection  of  the  an- 
terior part  of  the  neck,  called  Processus  Gracilis,  and  a 
short  one  on  the  outside  below  the  other,  called  Processus 
Brevis,  which  sends  out  a round  ligament  to  the  edge  of 
the  tympanum. 

This  ligament  is  described  by  some  as  the  Laxator  Tym- 
pani  Minor  Muscle. 

The  Incus  is  behind  the  malleus,  and  resembles  some- 
what a molar  tooth,  with  two  fangs  widely  separated,  one 
being  much  longer  than  the  other.  The  superior  and  ante- 
rior part  of  the  body  of  the  bone  is  excavated  for  articu- 
lating with  the  head  of  the  Malleus.  From  the  lower  part 
of  the  body  proceeds  the  Processus  Longus ; and  from  the 
back  part  looking  into  the  orifice  of  the  mastoid  cells  is  the 
Processus  Brevis. 

The  Os  Orbiculare,  is  a flattened  sphere,  about  the  size 
of  a mustard-seed,  placed  between  the  extremity  of  the 
long  process  of  the  Incus  and  the  Stapes. 

The  Stapes  resembles  very  much  a stirrup-iron,  and  is 
placed  horizontally  at  right  angles  with  the  malleus.  It 
has  a small  head,  articulating  with  the  os  orbiculare,  from 
which  proceed  an  anterior  and  a posterior  crus.  On  the 
inner  side  of  each  crus,  is  a fossa,  running  its  whole 
length.  The  crura  diverging  in  their  progress,  and  gently 
bent,  are  united  by  a broad  base,  which  corresponds  in 
its  dimensions  with  the  foramen  ovale,  over  which  it  is 
placed. 

To  get  a good  view  of  the  malleus  and  incus,  we  must 
cut  away  the  superior  margin  of  the  tympanum;  their  bo- 
dies will  then  be  seen  placed  vertically  and  in  contact,  a 
complete  articulation  being  formed  by  them. 

The  cavity  of  the  tympanum  is  lined  by  a delicate  and 
vascular  membrane,  continued  through  the  Eustachian 
Tube  from  the  pharynx,  and  into  the  Mastoid  Cells.  The 
little  bones  are  all  covered  by  a reflection  of  the  same, 
and  the  foramen  rotundum  is  closed  up  by  it. 

There  are  three  muscles  appropriated  to  the  movement 
of  these  bones,  two  to  the  Malleus,  and  the  other  to  the 
Stapes. 


THE  EAR. 


131 


A View  of  the  Labyrinth  and  Tympanum  of  the  Ear,  with  the 
Bones  in  Situ  ; highly  magnified. 

Fig.  32. 


1.  Processus  Longus  of  the  Malleus. 

2.  Its  Processus  Brevis. 

3.  Its  Manubrium. 

4.  Its  Neck. 

5.  Its  Head. 

6.  Body  of  the  Incus. 

7.  Its  Processus  Brevis. 

8.8.  Its  Processus  Longus,  with  the  little  head  for  articulating  with 
the  Stapes. 

9.  The  Head  of  the  Stapes. 

10.  Its  Anterior  Crus. 

11.  Its  Posterior  Crus. 

12.  Its  Base. 

13.14.15.  The  first  turn  of  the  Cochlea. 

1(5.17. 18.  Its  second  turn. 

19.  Its  half  turn. 

20.  The  Cupola. 

21.  The  Fenestra  Rotunda. 

22.23.  The  Vestibule. 

24.25.26.  Anterior  Semicircular  Canal. 

27.  Its  junction  with  the  Posterior  Canal. 

28.29.30.31.  The  Posterior  Semicircular  Canal. 

32.33.34.35.  The  External  Semicircular  Canal.  The  Enlargements 
on  these  Canals  are  called  Ampul®. 


132 


OF  THE  HEAD  AND  NECK. 


The  Laxator  Tympani,  placed  in  the  glenoid  fissure  of 
the  temporal,  and  arising  from  the  spinous  process  of  the 
sphenoid  bone,  is  inserted  into  the  processus  gracilis  of 
the  Malleus.  It  draws  the  Malleus  forward  and  out- 
wards, so  as  to  relax  the  membrane  of  the  tympanum. 

The  Tensor  Tympani,  arises  from  the  cartilage  of  the 
Eustachian  tube,  lies  in  its  upper  bony  part  and  is  inserted 
by  a tendon  into  the  neck  of  the  malleus,  a little  below  the 
processus  gracilis.  It  draws  the  handle  of  the  malleus 
inwards,  and  makes  tense  the  membra  tympani. 

The  Stapedius,  arises  from  the  bottom  of  the  cavity  of 
the  pyramidal  process,  and  is  inserted  by  a delicate  round 
tendon  into  the  head  of  the  Stapes.  It  draws  this  bone 
backwards. 

3.  THE  LABYRINTH. 

To  obtain  a good  view  of  this  structure,  a foetal 
bone  must  be  procured,  as  the  labyrinth  is  more  acces- 
sible in  it,  and  nearly  as  fully  developed  as  in  the  adult. 
The  petrous  bone  here  has  a condensed  but  thin  struc- 
ture on  its  surface,  which  being  removed,  brings  into 
view  a soft  cellular  bone,  easily  managed  with  a pen- 
knife. By  paring  it  away,  we  come  in  contact  with  the 
labyrinth,  which  is  readily  recognised  by  its  hardness  and 
brittleness,  and  may  be  got  out  with  but  little  trouble. 
Having  proceeded  thus  far,  the  labyrinth  is  seen  to  consist 
of  three  parts;  above  and  posteriorly  are  the  Semicircu- 
lar Canals,  in  the  centre  is  the  Vestibule,  and  below  is  the 
Cochlea.  The  whole  of  this  structure  is  hollow. 

The  Semicircular  Canals,  attached  to  the  back  and  up- 
per part  of  the  vestibule,  are  so  situated  that  one  is  Supe- 
rior, another  Posterior,  and  the  third  Exterior.  The  su- 
perior and  posterior  are  united  together  at  their  upper 
extremities,  and  therefore  have  a common  canal  entering 
into  the  vestibule;  their  other  extremities  are  widely  di- 
vergent from  each  other,  and  enlarged,  each  forming  an 
ampulla  before  it  enters  into  the  vestibule.  The  exterior 
canal  is  shorter  than  the  others,  lies  nearly  horizontal,  and 


THE  EAR. 


133 


has  its  external  extremity  enlarged  also  into  an  ampulla, 
which  is  placed  near  the  ampulla  of  the  superior  canal. 
These  three  canals,  from  two  of  them  uniting,  have  only 
five  orifices  in  the  vestibule. 

The  Vestieule  has  a cavity  about  the  size  of  a grain  of 
barley,  and  is  placed  just  on  the  inner  part  of  the  bottom 
of  the  tympanum.  The  foramen  ovale  is  the  common 
orifice  between  them.  On  the  superior  and  exterior  part 
of  the  cavity,  contiguous  to  the  openings  of  the  canals,  is 
the  semi-elliptical  depression,  and  below  this  and  some- 
what more  internally,  is  the  hemispherical  depression,  the 
recollection  of  both  of  which  will  be  useful  to  us  at  a 
subsequent  period  of  the  description.  At  the  lower  part 
of  the  vestibule  is  a foramen  communicating  with  the  ca- 
vity of  the  cochlea. 

The  Cochlea,  consists  of  a conical  tube  wound  spirally 
two  and  a half  times  on  itself,  and  is  fixed  at  the  anterior 
part  of  the  vestibule.  It  has  a broad  cribriform  base, 
forming  the  bottom  of  the  meatus  auditorius  internus,  and 
an  apex  which  occasions  the  promontory  in  the  tympa- 
num. Passing  from  its  base  towards  the  apex,  is  a pillar 
of  bone  called  Modiolus,  on  which  the  conical  tube  is 
wound.  This  pillar  tapers  almost  to  a point,  and  then  is 
spread  out  into  a cavity  resembling  a funnel,  from  whence 
the  name  Infundibulum.  The  apex  of  the  cochlea,  from 
its  covering  over  the  Infundibulum,  is  called  the  Cupola. 

When  the  conical  tube  is  cut  open  freely,  a partition  is 
seen  to  divide  it  into  two  equal  portions  from  the  base  to 
the  summit.  This  partition,  called  Lamina  Spiralis,  arises 
by  two  delicate  lamellae  of  bone  with  an  intermediate  cellular 
structure,  from  the  Modiolus,  but  does  not  go  completely 
across  the  canal,  for  on  minute  examination,  the  lamina 
spiralis  is  seen  to  consist  besides  cartilage,  of  a cellular 
portion  containing  a fluid,  and  of  a membrane.  These 
portions  are  called  Zones,  we  therefore  have  Zona  Ossea, 
Coriacea,  Vesicularis,  and  Membranacea.  The  lamina 
spiralis  terminates  in  the  infundibulum  by  a process  called 
Hamulus. 

The  divisions  in  the  Cochlea,  thus  made  by  the  lamina 
spiralis  form  the  scalse.  The  lowest  of  these  scahe,  has  the 


134 


OF  THE  HEAD  AND  NECK. 


foramen  rotundum  from  the  tympanum,  looking  into  its  base, 
and  the  upper,  communicates  by  the  foramen  at  the  bottom 
of  the  vestibule,  with  the  cavity  of  the  vestibule.  From 
these  communications  we  have  the  names  Scala  Tympani, 
and  Scala  Vestibuli.  The  scalae  communicate  also  with  each 
other,  just  at  the  hamulus,  in  the  infundibulum. 

The  whole  labyrinth  is  lined  by  a highly  vascular  mem- 
brane, exhibited  by  our  preparations  in  the  University,  which 
seems  to  be  very  different  from  common  periosteum. 

Thus  far  the  description  has  applied  only  to  the  bony 
labyrinth,  but  by  removing  it  we  shall  find  besides  the  vas- 
cular membrane  just  mentioned,  the  following  parts.  Three 
Membranous  Semicircular  Canals  within  the  bony,  conform- 
ing to  their  figure  and  containing  a pellucid  fluid ; these 
canals  all  communicate  by  their  extremities  with  a sac  called 
Sacculus  Ellipticus,  and  by  Scarpa  from  its  function,  Alveus 
Communis,  situated  in  the  semi-elliptical  depression  of  the 
vestibule.  In  it  are  found  some  small  crystalline  pulverulent 
masses  of  a calcareous  composition,  which  are  thought  to 
contribute  to  the  auditive  function  of  the  Labyrinth,  and 
are  called  Otoconie  by  Mr.  Breschet.  Within  the  vestibule, . 
and  occupying  the  hemispherical  cavity,  is  another  and 
smaller  sac  like  a bubble,  filled  with  a transparent  fluid, 
distinct  from  the  former,  and  called  the  Sacculus  Sphericus. 
To  complete  this  part  of  the  description  of  the  labyrinth, 
it  is  to  be  observed  that  between  the  bony  and  membranous 
canals,  in  the  vestibulum  on  the  outside  of  the  sacs,  and  in 
the  scalae  of  the  cochlea,  is  to  be  found  a transparent  fluid, 
which  can  pass  from  one  of  these  cavities  into  the  other  by 
the  foramina  already  mentioned. 

It  is  in  connexion  with  this  fluid  that  we  find  the  two  sup- 
posed aqueducts  for  its  removal,  called  after  Cotunnius,  one 
for  the  Vestibule,  another  for  the  Cochlea.  The  first  arises 
near  the  common  orifice  of  the  superior  and  posterior  semi- 
circular canals,  and  discharges  itself  just  behind  the  meatus 
auditorius  internus.  The  other  comes  from  the  cochlea  near 
the  foramen  rotundum,  and  runs  into  the  jugular  fossa  just 
at  the  root  of  the  spine  for  separating  the  eighth  pair  of 
nerves  from  the  internal  jugular  vein.  In  investigating  these 
canals,  Mr.  Ribes  has  since  ascertained  that  they  only  con- 


THE  EAR. 


135 


duct  blood-vessels,  and  that  Cotunnius  and  others  were  in 
error  in  regard  to  their  functions. 

The  Nerve  of  Hearing,  or  the  Portio  Mollis,  is  dis- 
tributed throughout  the  labyrinth.  The  bottom  of  the 
meatus  internus  being  divided  into  two  unequal  fossse  by  a 
ridge,  the  uppermost  is  the  smaller  and  perforated  with 
several  foramina,  all  of  which  except  the  anterior  large  one, 
are  appropriated  to  the  passage  of  the  portio  mollis  to  the 
vestibule.  The  larger  fossa  at  the  bottom  of  the  meatus,  is 
also  cribriform,  and  forms  the  basis  of  the  cochlea ; through 
it  pass  fibrillae  to  the  cochlea,  vestibule,  and  semicircular 
canals.  The  portio  mollis,  descending  to  the  bottom  of  the 
meatus,  passes  in  several  divisions  to  the  soft  structure 
within  the  bony  labyrinth.  One  division  entering  the  vesti- 
bule, is  spent  on  the  alveus  communis  and  membranous 
canals ; another  division  goes  to  the  sacculus  sphericus.  A 
third  division,  penetrating  from  the  base  of  the  modiolus, 
runs  through  it  and  comes  out  upon  the  lining  membrane  of 
the  cochlea,  between  the  plates  of  the  lamina  spiralis,  and 
through  the  infundibulum  and  other  parts.  The  fibrillse  of 
the  portio  mollis  during  this  distribution,  continue  exceed- 
ingly delicate,  and  are  finally  found  in  a pulpy  state  re- 
sembling the  retina,  upon  the  internal  surface  of  the  cavities 
and  sacs  just  mentioned. 

The  Portio  Dura,  though  not  concerned  in  the  function 
of  hearing,  passes  through  the  petrous  bone  in  a curious 
manner.  Entering  into  the  large  foramen  in  the  upper  fossa 
of  the  meatus  internus,  it  goes  outwards  almost  as  far  as 
the  vidian  foramen  and  there  makes  a very  abrupt  turn  back- 
wards, forming  an  acute  angle  called  its  elbow.  It  then 
runs  just  above  the  foramen  ovale,  making  a ridge  in  the 
tympanum ; continues  its  course  so  as  to  surround  the  back 
part  of  the  tympanum,  and  emerges  at  the  foramen  stylo- 
mastoideum.  It  is  afterwards  distributed  to  the  face.  Its 
canal  in  the  bone  is  called  the  Aqueduct  of  Fallopius.  Near 
the  vidian  foramen,  it  sends  a filament  to  the  tensor  tympani 
and  at  the  base  of  the  pyramid,  one  to  the  stapedius. 

The  Chorda  Tympani,  a branch  of  the  pterygoid  nerve, 
passes  into  the  vidian  foramen  and  joins  the  portio  dura, 


136 


OF  THE  HEAD  AND  NECK. 


running  closely  connected  with  it  almost  to  the  stylo-mastoid 
foramen.  It  then  leaves  the  portio  dura  at  an  acute  angle,  en- 
ters into  the  back  part  of  the  tympanum  and  crosses  this  cavity 
completely,  by  going  between  the  long  leg  of  the  incus  and 
the  handle  of  the  malleus.  It  gets  from  ihe  tympanum 
through  the  glenoid  foramen  and  joins  ultimately  the  lingual 
branch  of  the  fifth  pair  of  nerves. 

The  labyrinth  is  principally  supplied  with  blood  from  a 
branch  of  the  vertebral  artery,  which  gets  to  it  through  the 
meatus  internus.  The  tympanum  and  external  ear  are  sup- 
plied from  the  stylo-mastoid  and  temporal  arteries. 


SECTION  VIII. 

Of  the  Nose. 

In  order  to  understand  this  part  of  our  structure,  it  is  ne- 
cessary to  be  well  acquainted  with  the  bones  constituting 
its  cavity,  both  individually  and  collectively.  Being  thus 
prepared,  we  shall  see  that  the  nostrils  which  are  incom- 
pletely separated  from  each  other  in  the  skeleton,  have  a 
perfect  septum  in  the  recent  subject,  which  renders  them 
two  distinct  cavities.  This  is  effected  by  a cartilage  placed 
at  the  anterior  part  of  the  vomer  and  of  the  nasal  lamellae 
of  the  aethmoid  bone.  At  the  junction  of  this  cartilage  with 
the  nasal  suture,  it  spreads  out  on  each  side  into  a wing, 
which  is  attached  to  the  lower  edge  of  the  nasal  bones 
and  the  adjoining  margin  of  the  nasal  process  of  the  upper 
maxillary,  and  extends  by  such  means,  the  bridge  of  the 
nose. 

Proceeding  from  the  lower  edge  of  the  wing  of  this  car- 
tilage,  and  from  the  external  bony  margin  of  the  anterior 
naris,  is  an  elastic  ligamentous  membrane  forming  the  side 
of  the  nostril.  At  the  anterior  part  of  this  membrane  is  an 
oval  cartilage,  which  forms  two-thirds  of  a ring,  the  exte- 
rior portion  of  it  is  the  broadest;  the  internal  portion, 
placed  in  contact  with  the  corresponding  part  of  the  oval 


THE  NOSE. 


137 


cartilage  of  the  other  side,  runs  backwards,  and  forms  by 
the  union,  the  Columna  Nasi.  In  the  back  of  the  ligamen- 
tous membrane  there  are  several  detached  pieces  of  carti- 
lage, which  give  firmness  to  the  structure,  and  produce  the 
prominence  of  the  ala  nasi.  It  is  by  means  of  these  several 
cartilages  that  the  orifice  of  the  nostril  is  kept  open. 

The  posterior  nares  being  separated  by  the  vomer,  are 
oval,  and  do  not  present  an  outline  differing  much  from  that 
produced  by  the  naked  bone.  At  the  posterior  extremi- 
ties of  the  inferior  turbinated  bones  are  the  orifices  of  the 
Eustachian  Tubes,  placed  obliquely,  and  large  enough  to 
admit  the  end  of  the  little  finger.  It  is  not  difficult  to 
reach  them  with  an  instrument  gently  curved,  introduced 
through  the  inferior  meatus  of  the  nose,  an  operation  fre- 
quently required  in  cases  of  deafness.  They  are  here 
partly  membranous,  and  partly  cartilaginous,  running  up- 
wards and  outwards,  to  the  bony  canal  leading  to  the  cavity 
of  the  tympanum. 

The  Schneiderian  Membrane,  is  spread  over  all  the 
bones  composing  the  nostril,  and  by  its  thickness  diminishes 
the  foramen  leading  into  the  sinuses.  Under  the  anterior 
part  of  the  middle  spongy  bone,  is  an  orifice  which  leads 
through  the  ethmoidal  cells  into  the  frontal  sinus.  At  the 
middle  part  of  the  middle  meatus,  or  that  between  the 
lower  and  middle  spongy  bones,  is  the  opening  into  the 
Antrum  Highmorianum,  capable  of  giving  entrance  to  a 
common  quill.  In  the  meatus  formed  posteriorly  in  the 
ethmoid  bone,  under  the  cornet  of  Morgagni,  are  the  orifices 
of  the  posterior  ethmoidal  cells ; at  the  back  part  of  this 
cornet,  and  a little  above  it,  is  the  orifice  of  the  sphenoidal 
sinus.  Immediately  under  the  fore  part  of  the  inferior 
spongy  bone  is  the  orifice  of  the  Ductus  ad  Nasum.  This 
membrane  is  laid  smoothly  on  the  septum  of  the  nose. 

The  Schneiderian  or  mucous  membrane  when  well  in- 
jected, shows  great  vascularity;  its  reflections  into  the  si- 
nuses are  not,  however,  so  thick  or  vascular  as  the  other 
parts  of  it.  The  surface  which  looks  towards  the  cavity 
of  the  nose  is  villous  like  velvet,  and  is  studded  with  many 
mucous  follicles  which  pass  obliquely  into  it,  some  of  them 
being  arranged  in  rows.  It  adheres  closely  to  the  bones, 
and  that  surface  in  the  compactness  of  its  texture  resembles 
periosteum. 


138 


OF  THE  HEAD  AND  NECK. 


Its  nerves  are  derived  from  three  sources. 

1.  The  Olfactory,  or  Nerves  of  Smelling.  They  pass 
on  each  side  of  the  crista  galli,  in  two  rows,  perforating  the 
cribriform  plate,  and  taking  a coat  of  dura  mater  which  ren- 
ders them  strong  and  fibrous.  One  row  is  spread  on  the 
membrane,  covering  the  upper  part  of  the  sethmoid  bone, 
and  descends  as  low  as  the  inferior  edge  of  the  middle 
spongy  bone ; the  other  is  distributed  to  the  membrane  of 
the  nasal  septum  and  its  fibres  descend  somewhat  lower. 
The  fibrilloe  of  these  nerves  terminate  on  the  nasal  surface 
of  the  membrane. 

A View  of  the  First  Pair  or  Olfactory  Nerves,  with  the 
Nasal  Branches  of  the  Fifth  Pair. 

Fig.  33. 


1.  Frontal  Sinus. 

2.  Sphenoidal  Sinus. 

3.  Hard  Palate. 

4.  Bulb  of  the  Olfactory  Nerve. 

5.  Branches  of  the  Olfactory  Nerve  on  the  Superior  and  Middle  Turbi- 

nated Bones. 

6.  Spheno-Palatine  Nerves  from  the  Second  Branch  of  the  Fifth 

Pair. 

7.  Internal  Nasal  Nerve  from  the  first  Branch  of  the  Fifth. 

8.  Branches  of  7 to  the  Schneiderian  Membrane. 

9.  Ganglion  of  Cloquet  in  the  Foramen  Incisivum. 

10.  Anastomosis  of  the  branches  of  the  Fifth  Pair  on  the  Inferior  Tur- 
binated  Bone. 


THE  MOUTH. 


139 


2.  The  Spheno-Palatine  Nerve,  comes  from  the  Spheno- 
Palatine  Ganglion  through  the  spheno-palatine  foramen,  and 
gives  fibres  to  the  septum  and  lateral  parts  of  the  nose.  One  of 
the  former  dips  into  the  anterior  palatine  foramen,  joins  with 
its  fellow  from  the  other  side,  and  forms  a ganglion  near  the 
roof  of  the  mouth. 

3.  The  Nasal  Nerve  of  the  First  Branch  of  the  Fifth 
Pair,  passing  through  the  anterior  aethmoidal  foramen  into 
the  cranium,  dips  down  at  the  side  of  the  crista  galli  into  the 
nose,  and  may  be  traced  along  the  nasal  bone  to  the  tip  of 
the  nose. 

The  nose  is  supplied  principally  with  Blood  from  the  in- 
ternal maxillary  artery,  and  from  the  aethmoidal  branches  of 
the  ophthalmic.  Its  veins  accompany  the  arteries. 


SECTION  IX. 

The  Mouth. 

The  cavity  of  the  mouth,  is  chiefly  formed  by  the  palatine 
process  of  the  upper  maxillary  and  palate  bones,  above  ; by 
the  tongue,  and  the  muscles  connected  with  it,  below ; by 
the  cheeks  laterally  ; by  the  lips  before ; and  by  the  soft 
palate  behind. 

The  Tongue  has  its  root  at  the  os  hyoides,  and  is  there 
thin,  but  broad;  its  tip  and  sides,  owing  to  the  lining 
membrane  passing  a considerable  way  under  them  before  it 
is  reflected  to  the  organ,  are  left  free.  Four  pairs  of  mus- 
cles compose  its  bulk.  The  Stylo-Glossus,  which  arises 
from  the  anterior  part  of  the  styloid  process,  and  is  inserted 
into  the  side  of  the  tongue  near  its  root,  the  fibres  going  to 
the  tip.  The  Hyo-Glossus,  which  arises  broad  and  thin 
from  the  cornu,  appendix,  and  body  of  the  os  hyoides,  and 
forms  a considerable  part  of  the  bulk  of  the  tongue  on  its  side. 
The  Lingualis,  which  arises  indistinctly  from  the  root  of  the 


140 


OF  THE  HEAD  AND  NECK. 


tongue  on  the  inner  side  of  the  former  muscle,  and  its  fibres 
are  to  be  traced  as  far  as  the  tip.  And  lastly,  the  Genio-Hyo- 
glossus  muscle,  the  most  internal  of  the  four,  lying  in  con- 
tact with  its  fellow  of  the  opposite  side.  It  arises  from  the 
tubercle  on  the  posterior  face  of  the  symphysis  of  the  lower 
jaw ; its  fibres  radiate  so  as  to  be  inserted  from  the  body  of 
the  os  hyoides  to  the  tip  of  the  tongue.  Besides  these  regu- 
lar and  well  defined  muscles,  there  are  many  fibres  which 
cross  the  organ  in  various  directions,  and  facilitate  much  its 
motion.  They  are  the  Superficialis  Linguae  forming  a thin 
layer  on  the  upper  surface  of  the\ongue ; the  Transversales 
Linguae  being  scattered  fasciculi  going  horizontally,  and  the 
Verticales  Linguae  which  are  also  scattered  and"  go  ver- 
tically. 

The  superior  surface  of  the  tongue  on  its  anterior  two- 
thirds  is  rough  from  the  presence  of  a number  of  eminences 
on  it,  called  Papillae.  At  the  posterior  part  are  about  nine  of 
them,  arranged  like  the  letter  V,  with  the  point  backwards, 
much  larger  than  the  others.  They  are  fixed  in  pits,  and 
surrounded  by  a fold  of  the  integuments  ; from  their  parti- 
cular form,  they  have  been  called  Papillae  Capitatae  or  Max- 
imae.  Distributed  over  the  tongue,  and  scattered  at  irregu- 
lar distances  from  each  other,  are  the  Papillae  Mediae,  more 
numerous  than  the  others,  and  smaller.  A third  class  of 
them,  occupies  by  far  the  greater  part  of  the  surface  of  the 
tongue,  and  are  called  Papillae  Yillosse.  And  a fourth  set 
of  them,  filling  up  the  intervals  left  between  the  others  and 
being  the  smallest  of  any,  are  called  Papillae  Filiformes.  It 
is  probable  that  these  Papillae,  except  the  first,  are  essenti- 
ally connected  with  the  function  of  taste,  as  they  are  abun- 
dantly supplied  with  nerves  and  blood-vessels,  having  a pe- 
culiar arrangement. 

At  the  posterior  part  of  the  tongue  is  a fold  of  the  mem- 
brane covering  it,  which  rises  up  to  join  the  Epiglottis  car- 
tilage ; and  within  this  duplicature  is  a ligamentous  bridle 
serving  to  keep  the  Epiglottis  cartilage  erect;  muscular 
fibres  from  the  base  of  the  tongue  form  its  commencement. 
On  each  side  of  it  is  a small  pouch,  which  occasionally  pro- 
duces some  trouble  from  articles  of  food  lodging  in  it.  A 
little  anterior  to  this  fold  is  a small  blind  hole,  receiving  tire 
central  papilla  maxima  and  into  which  some  mucous  glands 
discharge  their  contents,  it  is  called  the  Foramen  Caecum  of 


THE  MOUTH. 


141 


Morgagni ; and  sometimes  behind  it  is  another  foramen  cae- 
cum, but  without  a papilla.  Scattered  about  the  root  of  the 
tongue  we  find  many  mucous  glands. 

The  lining  membrane  of  the  mouth,  when  the  cuticle  is 
separated  from  it  by  maceration,  exhibits  a surface  covered 
with  fine  vilii.  On  the  lips  and  cheeks,  under  it,  are  situ- 
ated many  small  glandular  bodies,  called  Glandulae  Labi- 
ales,  and  Buccales.  It  forms  a frsenum  where  it  is  reflected 
from  the  upper  and  lower  lips  to  the  centre  of  the  jaw 
bones.  On  the  alveolar  processes,  its  texture  is  more  dense, 
constituting  the  gums,  which  closely  surround  the  necks  of 
the  teeth.  The  membrane  is  also  united  to  the  lowrer  side 
of  the  tongue  by  a frsenum,  on  each  side  of  which  wre  see 
the  orifices  of  the  ducts  of  the  sub-maxillary  glands.  Un- 
der the  tongue,  at  its  side,  and  projecting  into  the  cavity  of 
the  mouth,  but  covered  by  the  lining  membrane,  is  the  Sub- 
lingual Gland,  opening  by  fifteen  or  twenty  distinct  orifices. 
On  the  cheeks,  opposite  the  interstice  of  the  second  and 
third  molar  teeth  of  the  upper  jawT,  is  found  the  orifice  of 
the  duct  of  the  Parotid  Gland. 

The  lining  membrane  of  the  roof  of  the  mouth  is  of  a 
dense  structure,  having  a ridge  in  it  just  under  the  middle 
palate  suture,  and  on  each  side  of  that,  transverse  ridges 
extending  towards  the  alveolar  processes.  It  adheres  very 
closely  to  the  bone,  and  beneath  are  to  be  found  many  mu- 
cous glands  of  various  sizes,  having  their  excretory  ducts 
terminating  on  the  surface  of  the  palate. 


OF  THE  FAUCES. 

At  the  posterior  part  of  the  mouth  may  be  seen,  very  dis- 
tinctly, by  depressing  the  lower  jaw,  an  incomplete  parti- 
tion, which  divides  it  from  the  pharynx.  It  is  the  Velum 
Pendulum  Palati,  formed  by  the  lining  membrane  of  the 
mouth  reflected  over  several  muscles.  In  the  centre  is  a 
projection  termed  Uvula.  On  each  side  of  the  uvula,  the 
soft  palate  has  its  inferior  margin  terminating  in  two  cre- 
scentic ridges,  called  its  lateral  half  arches.  The  anterior 
half  arch  is  rather  more  distinct  than  the  posterior,  and 
arising  from  the  side  of  the  uvula,  runs  around  to  be  in- 
serted into  the  side  of  the  basis  of  the  tongue.  The  pos- 


142 


OF  THE  HEAD  AND  NECK. 


terior  half  arch,  arising  from  the  side  of  the  uvula  near  the 
anterior,  runs  backwards  and  outwards,  and  is  lost  insensi- 
bly about  the  middle  of  the  pharynx.  Between  the  half 
arches,  on  each  side,  is  placed  the  Tonsil  Cland,  the  surface 
of  which  is  commonly  so  reticulated,  that  it  might  readily 
be  mistaken  for  ulceration.  The  space  between  the  lateral 
half  arches,  is  the  Fauces,  and  the  anterior  opening  into  it, 
is  the  Isthmus  of  the  Fauces. 

By  dissecting  off  the  membrane  of  the  soft  palate,  which 
is  continued  from  the  mouth,  several  mucous  glands  are 
brought  into  view  lying  immediately  under  it,  and  also  the 
muscular  structure,  which  is  as  follows  : 

1.  In  the  anterior  half  arch  is  the  Constrictor  Isthmi 
Faucium,  which  arises  from  the  middle  of  the  soft  palate 
near  the  root  of  the  uvula,  and  is  inserted  into  the  side  of 
the  tongue  near  its  root,  in  a line  with  the  papillae  maximae. 
It  tends  to  close  the  opening  between  the  mouth  and  the 
pharynx. 

2.  In  the  posterior  half  arch  is  the  Palato-Pharyngecs. 
It  arises  from  the  middle  of  the  soft  palate  behind,  near 
the  root  of  the  uvula,  and  is  inserted  in  the  pharynx  be- 
tween the  middle  and  lower  constrictors  and  into  the  supe- 
rior posterior  margin  of  the  Thyroid  Cartilage.  It  draws 
the  velum  palati  downwards. 

3.  The  Circumflexus  or  Tensor  Palati,  arises  from  the 
spinous  process  of  the  sphenoid  bone  behind  the  foramen 
ovale,  and  from  the  contiguous  part  of  the  Eustachian  tube, 
it  passes  in  contact  with  the  pterygoideus  internus  muscle, 
and  terminates  in  a broad  tendon  below,  which  winds 
around  the  hook  of  the  internal  pterygoid  process,  and  is 
inserted  into  the  soft  palate  near  its  middle,  and  into  the 
posterior  lunated  edge  of  the  palate  bone.  It  spreads  out, 
or  extends  the  palate. 

4.  The  Levator  Palati,  arises  from  the  point  of  the  pe- 
trous bone  and  contiguous  part  of  the  Eustachian  tube;  it 
is  on  the  inner  side  of  the  former  muscle,  and  passes  down- 
wards to  be  inserted  into  the  soft  palate.  It  draws  the  soft 
palate  upwards. 


PHARYNX  AND  (ESOPHAGUS. 


143 


5.  The  Azygos  Uvulas  arises  from  the  posterior  termi- 
nation of  the  palate  suture,  runs  through  the  centre  of  the 
soft  palate,  and  ends  in  the  point  of  the  uvula.  It  draws 
the  uvula  upwards  and  diminishes  the  vertical  breadth  of 
the  soft  palate. 


SECTION  X. 

Of  the  Pharynx  and  (Esophagus. 

The  Pharynx,  is  a large  membranous  cavity  placed  at 
the  posterior  part  of  the  nose  and  of  the  mouth,  for  opening 
an  external  communication  with  the  cavities  of  the  thorax 
and  abdomen.  It  lies  before  the  cervical  vertebra,  being 
connected  to  them  by  cellular  substance,  is  closely  attached 
to  the  basis  of  the  skull  before  the  foramen  magnum,  to  the 
posterior  margin  of  the  upper  and  under  jaws,  to  the  back 
parts  of  the  os  hyoides  and  of  the  thyroid  and  cricoid  car- 
tilage, and  below,  it  contracts  so  as  to  be  continuous  with 
tire  cesophagus.  In  consequence  of  these  several  attach- 
ments, it  constantly  remains  a patulous  unoccupied  cavity, 
having  a free  communication  with  the  nostrils  and  Eusta- 
chian tubes  above,  with  the  mouth  just  below  them,  with 
the  larynx  still  lower  down,  and  with  the  oesophagus  at  its 
bottom.  The  lining  membrane  which  is  expanded  over  it, 
is  continuous  with  the  lining  membrane  of  these  several 
cavities. 

To  get  a good  view  of  the  pharynx,  the  head  ought  to 
be  cut  off  at  the  root  of  the  neck,  and  all  the  cervical  ver- 
tebra be  removed  ; the  cavity  being  then  stuffed  with 
baked  hair,  we  proceed  to  the  dissection  of  the  muscles 
which  form  it,  of  which  there  are  three  pairs. 

1.  The  Constrictor  Pharyngis  Inferior,  arises  from  the 
side  of  the  cricoid  and  of  the  thyroid  cartilage  ; it  unites 
with  its  fellow  in  a white  line  in  the  centre  of  the  posterior 
part  of  the  pharynx.  Its  superior  fibres  are  very  oblique, 


144 


OF  THE  HEAD  AND  NECK. 


covering  the  lower  edge  of  the  next  muscle,  and  its  inferior 
fibres  are  more  transverse,  being  connected  with  the  oeso- 
phagus. 

2.  The  Constrictor  Pharyngis  Medius,  arises  from  the 
appendix  and  cornu  of  the  os  hyoides,  and  from  the  round 
ligament  connecting  the  latter  with  the  cornu  of  the  thyroid 
cartilage.  It  is  inserted  in  the  same  way  as  the  foregoing, 
into  its  fellow  and  into  the  cuneiform  process  of  the  os  oc- 
cipitis  just  before  the  recti  majores  muscles. 

3.  The  Constrictor  Pharyngis  Superior,  arises  from  the 
pterygoid  process  of  the  sphenoid  bone,  and  from  the  upper 
and  lower  jaw  bones,  behind  the  last  molar  teeth,  being  con- 
nected with  the  buccinator  muscle.  It  is  inserted  into  its 
fellow,  by  a white  line  in  the  middle  of  the  pharynx,  the 
upper  end  of  which  adheres  to  the  cuneiform  process  of 
the  os  occipitis  ; it  has  its  lower  edge  concealed  by  the  pre- 
ceding. 

These  muscles  all  assist  in  conveying  the  food  from  the 
mouth  into  the  oesophagus. 

The  pharynx,  after  the  dissection  of  these  muscles,  may 
be  cut  open  vertically  at  its  back  part,  when  a very  satis- 
factory view  of  all  the  cavities  connected  with  it  will  be 
obtained. 


THE  (ESOPHAGUS. 

This  is  a tube  leading  from  the  pharynx  to  the  stomach, 
it  is  placed  between  the  trachea  and  cervical  vertebrae  above, 
passes  into  the  thorax  between  the  laminae  of  the  posterior 
mediastinum,  in  contact  with  the  dorsal  vertebrae,  pene- 
trates through  the  left  foramen  of  the  diaphragm  and  ter- 
minates in  the  cardiac  orifice  of  the  stomach.  (See  Poste- 
rior Mediastinum.) 

The  (Esophagus  is  formed  of  three  coats,  the  muscular,  the 
cellular,  or  nervous,  and  the  mucous.  When  distended,  it  is 
cylindrical,  but  larger  below  than  above.  The  muscular  coat 
is  very  strong,  consisting  of  two  planes  of  fibres,  the  external 
being  longitudinal,  and  the  internal  circular.  The  nervous 


THE  LARYNX. 


145 


coat  connects  together  the  other  two  ; it  is  formed  of  cellu- 
lar substance,  which  allows  them  to  move  very  freely  upon 
each  other,  and  conducts  the  blood-vessels  through  their 
structure.  The  mucous  coat,  is  a continuation  of  that  of 
the  pharynx;  it  is  covered  by  a very  delicate  cuticle,  which 
is  continued  into  the  stomach,  and  forms  in  some  animals 
an  abrupt  and  well  marked  termination  just  at  the  cardiac 
orifice.  The  internal  coat  of  the  oesophagus,  is  most  fre- 
quently found  in  longitudinal  folds,  which  are  removed  by 
its  distension ; it  abounds  with  mucous  follicles,  and  is 
well  furnished  with  blood-vessels. 


SECTION  XI. 

Of  the  Larynx. 

By  the  term  Larynx,  is  understood  the  irregular  cartila- 
ginous tube  which  forms  the  upper  termination  of  the  wind- 
pipe. The  basis  of  the  structure,  is  made  by  five  distinct 
cartilages,  and  a crooked  bone,  the  os  hyoides,  which  is 
intermediate  to  the  larynx  and  the  tongue,  serving  the  pur- 
poses of  both. 

The  Os  Hyoides  resembles  much  the  letter  U,  and  is  di- 
vided into  its  base  or  curved  part  and  its  cornua,  or  lateral 
projections.  It  is  parallel  with  the  lower  j aw  and  about 
half. an  inch  below  it.  It  acts  as  a root  to  the  tongue;  as 
two  arms  in  holding  out  the  bag-like  orifice  of  the  Pharynx ; 
and  from  it,  is  suspended  the  Larynx.  The  base  of  the  os 
hyoides  is  broad  and  convex  anteriorly;  above,  it  is  flattened 
on  each  side  by  the  insertion  of  muscles  from  the  lower 
jaw,  and  at  its  posterior  part,  it  is  excavated  sufficiently  to 
receive  the  tip  of  the  little  finger.  At  the  ends  of  the  base, 
the  two  cornua  arise,  separated  from  it  by  cartilage  and 
therefore  moveable ; they  are  about  an  inch  long,  are  some- 
what flattened,  and  have  a tuberculated  termination  behind. 
On  the  cartilaginous  interval  of  each  side,  is  placed  a bony 
body  about  the  size  of  a grain  of  wheat,  the  Appendix, 
10 


146 


OF  THE  HEAD  AND  NECK. 


which  stands  up  obliquely  towards  the  styloid  process,  and 
is  connected  to  its  tip  by  a round  ligament  resembling  a 
nerve ; this  ligament  in  some  cases  has  been  found  ossified 
in  the  greater  part  of  its  length.  The  five  cartilages  of  the 
Larynx  are  the  Thyroid,  Cricoid,  two  Arytenoid,  and  the 
Epiglottis. 

The  Thyroid  Cartilage,  (Cartilago  Thyroidea,)  is 
about  an  inch  below  the  os  hyoides,  and  forms  a very 
striking  prominence  in  the  male  neck.  It  consists  of  flat 
sides,  which  are  symmetrical,  and  united  to  each  other  by 
an  angle  slightly  acute  at  its  anterior  part ; the  upper  place 
of  union  forms  the  projection  called  Pomum  Adami.  The 
sides  of  this  body  lean  over  somewhat,  by  which  its  trans- 
verse diameter  above,  is  somewhat  larger  than  that  below. 
The  upper  edge  is  notched  in  front,  and  terminates  behind 
by  a long  process  on  each  side,  the  Cornu  Majus,  which 
looks  towards  the  end  of  the  cornu  of  the  os  hyoides,  and 
is  connected  to  it  by  a round  cord,  the  posterior  thyro- 
hyoid ligament.  The  inferior  edge  is  somewhat  incurvated, 
and  terminates  behind  by  a short  process  on  each  side,  the 
inferior  cornu,  or  Cornu  Minus,  by  which  it  is  fastened  by 
the  posterior  crico-thyroid  ligament,  to  the  side  of  the  cri- 
coid cartilage,  and  establishes  a centre  of  motion  between 
the  two. 

The  Cricoid  Cartilage,  (Cart.  Cricoides ;)  is  an  oval 
ring  of  unequal  breadth  and  thickness,  placed  immediately 
below  the  thyroid  cartilage.  Its  lower  margin  is  horizon- 
tal, and  affixed  to  the  first  ring  of  the  trachea;  the  upper 
margin  is  very  oblique,  rising  from  before  backwards,  till 
the  breadth  behind,  is  three  times  as  great  as  that  before. 
In  front  the  cricoid  cartilage  is  thin,  behind  it  is  thick.  On 
the  upper  edge  behind,  on  each  side,  a little  head  or  con- 
vexity is  formed,  for  establishing  a sort  of  ball  and  socket 
joint  with  the  arytenoid  cartilage.  The  interior  surface  is 
flat;  the  exterior  is  marked  by  the  muscles  which  lie  on  it. 

The  Arytenoid  Cartilages,  (Cart.  Arytaenoidece,  Tri- 
quetrae,)  two  in  number,  one  on  each  side  of  the  upper 
back  part  of  the  cricoid,  resemble  each,  a triangular  pyra- 
mid, curved  backwards,  and  having  an  excavated  base. 


THE  LARYNX. 


147 


The  internal  sides  of  the  two  are  flat,  face  each  other,  and 
by  the  action  of  their  muscles  may  be  brought  together ; 
when  thus  joined  they  resemble  the  spout  of  a pitcher.  In 
front  they  are  excavated  somewhat  irregularly.  On  the 
top  of  each,  is  a little  cartilaginous  tubercle,  about  the  size 
of  a grain  of  wheat,  (Corniculum  Laryngis,)  which  is  in- 
cluded in  the  soft  parts,  and  is  extremely  moveable.  There 
is  a regular  articular  cavity  between  the  cricoid  and  aryte- 
noid cartilages. 

The  Epiglottis  Cartilage,  (Epiglottis,)  is  an  oval  disk 
with  an  elongated  pedicle  below,  its  upper  edge  being  thin 
and  rounded.  It  is  fixed  behind  the  base  of  the  os  hyoides, 
and  has  its  pedicle  connected  to  the  entering  angle  on  the 
posterior  face  of  the  thyroid  cartilage.  The  broad  surfaces 
of  this  cartilage,  present  forwards  and  backwards,  and  are 
above  the  level  of  the  arytenoids  ; from  this  position  of  the 
epiglottis,  it  is  enabled  to  close  the  opening  of  the  larynx, 
in  consequence  of  the  larynx  and  it,  being  approximated  by 
the  thyro-hyoid  muscle.  It  is  very  elastic,  having  a fibro- 
cartilaginous structure,  and  is  perforated  with  many  fora- 
mina, giving  it  a cribriform  appearance. 

The  upper  edge  of  the  Thyroid  Cartilage,  is  connected 
to  the  internal  edge  of  the  Os  Hyoides,  by  a thin  and  some- 
what elastic  membrane,  the  Middle  Thyro-Hyoid  Ligament, 
which  fills  up  the  whole  of  this  interval,  and  completes  the 
front  and  lateral  parietes  of  the  Larynx.  Between  this 
membrane  and  the  cavity  in  the  base  of  the  os  hyoides,  is 
a small  sac,  and  considered  by  some  persons  as  a bursa 
mucosa.  It  has  no  connexion  with  any  other  cavity,  and 
is  occasionally  the  seat  of  disease.  When  its  secretion  be- 
comes excessive,  it  extends  down  as  far  as  the  isthmus  of 
the  thyroid  gland. 

Between  the  Epiglottis  and  the  Thyroid  Cartilage,  and 
on  the  posterior  face  of  the  Thyro-Hyoid  ligament,  is  a 
quantity  of  loose  fatty  matter,  intermixed  with  small  mucous 
glands ; the  perforations  in  the  epiglottis  are  supposed  to 
conduct  the  excretory  tubes  of  the  latter  into  the  Larynx. 

Between  the  Thyroid  and  Cricoid  cartilages,  in  front,  there 
is  a ligamentous  membrane  which  fills  up  this  interval ; it  is 


148 


OF  THE  HEAD  AND  NECK. 


the  middle  Crico-Thyroid  ligament,  and  in  Laryngotomy,  is 
indicated  as  the  proper  place  for  the  operation. 

From  the  anterior  part  of  the  base  of  each  arytenoid 
cartilage,  a ligament,  Thyro -Arytenoid,  passes  horizontally 
to  the  entering  angle  of  the  thyroid.  These  ligaments  are 
not  parallel,  but  converge  from  the  arytenoid  cartilages, 
and  are  very  near  each  other  in  front.  At  the  distance 
of  three  lines  above  these,  are  two  other  ligaments  passing 
also  horizontally  from  the  arytenoids  to  the  thyroid  carti- 
lage ; they  are  more  parallel,  but  have  not  their  ligamentous 
character  so  well  defined. 

There  are  several  pairs  of  muscles  belonging  to  the  Larynx. 

1.  The  Crico-Thyroideus,  arises  tendinous  and  fleshy 
from  the  anterior  lateral  surface  of  the  cricoid  cartilage,  and 
passes  upwards  and  backwards,  to  be  inserted  into  the  infe- 
rior cornu  of  the  thyroid  cartilage,  and  the  adjacent  part  of 
its  inferior  edge.  Use,  to  draw  these  cartilages  obliquely 
together. 


2.  The  Thyreo-IIyoideus,  which  is  described  in  the 
account  of  the  neck. 

3.  The  Crico-Arytenoideus  Posticus,  arises  from  the 
back  of  the  cricoid  cartilage,  occupying  its  excavation,  and 
is  inserted  into  the  posterior  part  of  the  base  of  the  aryte- 
noid cartilage.  Use,  to  draw  the  Arytenoid  backwards, 
and  make  the  ligaments  tense. 


Fig.  34. 


A Front  View  of  the  Crico-Thy- 


t.  Thyroid  Cartilage. 

2.  Crico-Thyroid  Ligament. 

3.  Right  Crico-Thyroid  Muscle. 

4.  Its  Origin. 

5.  Its  Insertion. 

G.  First  Ring  of  the  Trachea. 


roid  Muscles. 


THE  LARYNX. 


149 


4.  The  Crico-Arytenoideus  Lateralis,  arises  from  the 
side  of  the  cricoid  cartilage,  and  is  inserted  into  the  side  of 
the  base  of  the  arytenoid.  Use,  to  draw  this  cartilage  out- 
wards, and  open  the  chink  of  the  glottis. 

5.  The  Ti-iyreo-Arytenoideus,  arises  from  the  posterior 
face  of  the  thyroid  cartilage,  and  the  ligament  connecting 
it  with  the  cricoid,  and  is  inserted  into  the  anterior  edge  of 
the  arytenoid  cartilage.  Use,  to  relax  the  ligaments  of  the 
glottis. 

6.  The  Arytenoideus  Obliquus,  arises  from  the  base  of 
one  arytenoid  cartilage,  and  is  inserted  into  the  tip  of  the 
other.  It  is  a very  small  fasciculus,  and  sometimes  only 
one  muscle  exists.  Use,  to  close  the  chink  of  the  glottis. 

7.  The  Arytenoideus  Transversus,  arises  posteriorly 
from  the  whole  length  of  one  arytenoid  cartilage,  excepting 
a little  part  of  the  tip,  and  is  inserted  in  a corresponding 
manner,  into  the  other.  Use,  to  close  the  chink  of  the 
glottis. 

Fig.  35. 

A Vertical  Section  of  the  Larynx  to 

SHOW  SOME  OF  ITS  MUSCLES. 

1.  Cornu  Majus  of  the  Thyroid  Cartilage. 

2.  Its  Superior  Border. 

3.  Section  of  its  Body. 

4.  Its  Internal  Surface. 

5.  Arytenoid  Cartilage. 

6.  Posterior  Surface  of  the  Thyroid  Carti- 

lage. 

7.8.9.  Arytenoid  Muscles. 

10.11.12.  Thyreo-Arytenoid  Muscle. 

13.  Crico-A^tenoideus  Lateralis  Muscle. 

14.  Cricoid  Cartilage. 

15.16.17.  Crico-Arytenoideus  Posticus. 

18.19.  First  Rings  of  the  Trachea  united 

by  Ligament. 


8.  The  Thyreo-Epiglottideus,  arises  by  a few  fibres, 
from  the  posterior  face  of  the  thyroid  cartilage  near  its  en- 
tering angle,  and  is  inserted  into  the  side  of  the  Epiglottis. 
Use,  to  draw  the  epiglottis  downwards. 


150 


OF  THE  HEAD  AND  NECK. 


9.  The  Aryteno-Epiglottideus,  arises  by  a few  indis- 
tinct fibres,  from  the  superior  lateral  parts  of  the  arytenoid 
cartilage,  and  is  inserted  into  the  side  of  the  Epiglottis. 
Use,  to  draw  the  epiglottis  downwards. 

These  last  two  muscles  are  frequently  so  small  and  un- 
defined, that  they  cannot  be  satisfactorily  distinguished  from 
the  adjacent  soft  parts. 

The  cavity  of  the  Larynx,  is  lined  by  a continuation  of 
the  mucous  membrane  of  the  Pharynx.  This  membrane, 
where  it  establishes  the  upper  boundary  of  the  laryngeal 
cavity,  forms  a fold  on  each  side,  extending  from  the  Epi- 
glottis to  the  Arytenoid  Cartilage;  it  then  sinks  into  the 
cavity  beneath.  In  extending  from  the  upper  to  the  lower 
ligament  of  the  glottis,  on  each  side,  it  forms  a pouch  be- 
tween them,  called  the  ventricle  of  Galen  or  Morgagni. 
From  the  lower  ligament,  this  membrane  passes  to  line  the 
Cricoid  Cartilage,  and  thence  into  the  trachea. 

The  fissure  between  the  two  lower  ligaments,  is  the  Rima 
Glottidis,  and  the  cavity  above  the  upper  ligaments  is  the 
Glottis. 

For  an  account  of  the  Trachea,  see  the  article  Thorax. 


PART  II. 

OF  THE  TRUNK. 


CHAPTER  I. 

OF  THE  THORAX. 

The  dissection  of  the  cavity  of  the  Thorax,  should  be  pre- 
ceded by  that  of  the  muscles,  which  lie  upon  its  front  part 
and  sides. 


SECTION  I. 

Of  the  Muscles. 

1.  The  Pectoralis  Major  is  the  most  superficial,  and 
forms  the  large  swelling  cushion  of  flesh,  under  the  skin  of 
the  breast.  It  arises  tendinous,  from  the  anterior  face  of  the 
two  upper  bones  of  the  sternum  their  whole  length,  fleshy 
from  the  cartilages  of  the  fifth  and  sixth  ribs,  and  by  a fleshy 
slip  from  the  upper  part  of  the  tendon  of  the  external  oblique 
muscle.  It  arises  also  fleshy  from  the  interior  two-thirds  of 
the  clavicle.  The  clavicular  and  sternal  portions  of  the 


152 


OF  THE  TRUNK. 


origin  are  separated  by  an  interval,  giving  the  appearance 
of  two  muscles. 

The  fibres  converge,  and  terminate  by  a broad,  thin  ten- 
don, which  is  inserted  into  a roughness  on  the  exterior  edge 
of  the  bicipital  fossa  of  the  os  humeri,  and  into  the  brachial 
fascia,  just  at  the  internal  edge  of  the  deltoid  muscle.  The 
under  edge  of  the  muscle,  near  its  insertion,  is  folded  in- 
wards, which  gives  the  rounded  thick  margin  to  the  fore 
part  of  the  axilla.  That  part  of  the  broad  tendon  belonging 
to  the  clavicular  portion  of  the  muscle,  is  inserted  lower 
down  than  the  sternal,  which  produces  a decussation  of  the 
fibres  of  the  tendon. 

The  Pectoralis  Major,  draws  the  arm  inwards  and  for- 
wards, and  also  depresses  it  when  raised. 

2.  The  Pectoralis  Minor,  is  brought  into  view  by 
raising  the  last  muscle.  It  is  comparatively  small  and  some- 
what triangular,  arising  by  thin  tendinous  digitations  from 
the  upper  edges  of  the  third,  fourth,  and  fifth  ribs.  It  soon 
becomes  fleshy,  and  is  inserted,  by  a short  flat  tendon,  into 
the  inner  face  of  the  coracoid  process  of  the  scapula.  Its 
use  is  to  draw  the  scapula  inwards  and  downwards. 

3.  The  Subclavius,  is  a small  muscle  placed  immediately 
under  the  clavicle.  It  arises  from  the  cartilage  of  the  first 
rib,  and  is  inserted  into  the  inferior  face  of  the  clavicle,  from 
near  the  sternum  to  the  conoid  ligament,  which  connects 
the  coracoid  process  and  the  clavicle  together.  It  draws 
the  clavicle  downwards. 

4.  The  Serratus  Major  Anticus,  is  a broad  muscle 
lying  on  the  sides  of  the  ribs,  between  them  and  the  scapula, 
and  beginning  at  a line  anterior  to  their  middle.  In  well 
defined  bones,  the  precise  points  of  origin  are  readily  seen. 
It  arises  from  the  nine  upper  ribs  by  fleshy  digitations,  the 
superior  one  of  which,  seems  almost  like  a distinct  muscle; 
the  five  lower  are  connected  to  the  obliquus  externus  ab- 
dominis, the  digitations  of  the  two  muscles  interlocking 
with  each  other. 

The  fibres  converge,  and  are  inserted  into  the  base  of  the 
scapula  its  whole  length.  Its  action  is  to  draw  the  scapula 
forwards. 


MUSCLES  OF  THE  THORAX. 


153 


A View  of  the  Superficial  Muscles  of  the  Upper  Front  part  of 
the  Trunk. 


Fig.  36. 


1.  Sterno-Hyoid. 

2.  Sterno-Cleido  Mastoid. 

3.  Sterno-Thyroid. 

4.  Clavicular  portion  of  the  Sterno-CIeido-Mastoid. 

5.  Anterior  Edge  of  the  Trapezius. 

6.  Clavicle. 

7.  Clavicular  Origin  of  the  Pectoralis  Major. 

8.  Deltoid. 

9.  Fold  of  Fibres  of  the  Pectoralis  Major  on  the  Anterior  Edge  of 

the  Axilla. 

10.  Middle  of  the  Pectoralis  Major. 

11.  The  crossing  and  interlocking  of  the  Fibres  of  the  External  Ob- 

lique of  one  side  ef  the  Abomen  with  those  of  the  other. 

12.  Biceps  Flexor  Cubiti. 

13.  Teres  Major. 

14.  Serratus  Major  Anticus. 

15.  Superior  Heads  of  the  External  Oblique  interlocking  with  the  Ser- 

ratus Major. 


154 


OF  THE  TRUNK. 


5.  The  Intercostales  fill  up  the  spaces  between  the 
ribs.  There  are  two  in  each  space,  of  which  the  External 
arises  from  the  transverse  process  of  the  vertebra,  and  from 
the  inferior  acute  edge  of  each  rib,  from  its  head  almost  to 
its  cartilage,  and  is  inserted  into  the  superior  rounded  edge 
of  the  rib  below,  for  the  same  distance,  its  fibres  passing  ob- 
liquely forwards.  The  Internal  intercostal,  arises  from  the 
inferior  edge  of  the  rib  and  costal  cartilage,  beginning  at  the 
sternum,  and  extends  backwards  to  the  angle  of  the  rib;  it 
is  inserted  into  the  superior  rounded  edge  of  the  rib  and  cos- 
tal cartilage  below,  on  its  inner  side,  its  fibres  passing  ob- 
liquely backwards  and  downwards.  They  draw  the  ribs  to- 
gether. 

With  a view  to  examine  the  cavity  of  the  thorax,  the 
sternum  along  with  the  cartilages  of  the  ribs,  is  to  be  taken 
out  by  cutting  through  the  cartilages.  We  then  see,  on 
their  posterior  faces,  a muscle  called 

6.  The  Triangularis  Sterni,  which  arises  from  the  whole 
length  of  the  cartilago  ensiformis  at  its  edge,  and  from  the 
inferior  half  of  the  edge  of  the  second  bone  of  the  sternum. 
The  fibres  go  obliquely  upwards  and  outwards,  to  be  in- 
serted into  the  cartilages,  of  the  third,  fourth,  fifth  and  sixth 
ribs,  by  fleshy  and  tendinous  digitations.  Its  use  is  to  de- 
press the  ribs,  and  consequently  to  diminish  the  cavity  of 
the  thorax. 


SECTION  II. 

Viscera  of  the  Thorax. 

The  most  usual  manner  of  getting  into  the  cavity"  of  the 
Thorax  is  that  just  mentioned ; but  there  is  a much  better 
one  introduced  in  Philadelphia,  by  the  late  Professor  Wis- 
tar,  in  which  the  five  middle  true  ribs  on  each  side,  are  re- 
moved, all  the  rest  with  the  sternum  being  left.  This  plan 
gives  an  excellent  view  of  the  several  viscera,  and  also  of 
their  relative  situation  and  extent ; and  is  such  as  I would 
recommend  the  student  to  adopt,  in  at  least  one  dissection. 
The  principal  objection  to  it  is,  that  it  renders  the  upper 


VISCERA  OF  THE  THORAX. 


155 


parts  of  the  trunk  unfit  for  farther  investigation,  inasmuch 
as  the  superior  extremities  must  be  removed  in  the  first 
place.  If  the  muscles  connecting  the  upper  extremities  to 
the  trunk,  on  its  fore  and  back  parts,  should  have  been  pre- 
viously dissected,  this  objection  is  no  longer  valid. 

Approaching  the  cavity  of  the  thorax,  by  either  of  the 
methods  mentioned,  we  see  at  once  its  most  striking  con- 
tents, viz.  the  Heart  and  Lungs,  each  covered  by  an  appro- 
priate membrane.  The  heart  is  between  the  sternum  and 
the  dorsal  vertebrae ; the  lungs  are  on  each  side  of  it,  and, 
when  in  a healthy  state,  always  collapse  upon  the  thorax 
being  opened. 


THE  PLEURAE 

Each  of  the  two  lungs,  has  a perfect  serous  membrane 
called  Pleura,  which  covers  its  external  surface ; and  giving 
it  a glistening  smooth  appearance,  is  reflected  from  the  in- 
ternal face  of  the  lung,  over  the  side  of  the  pericardium,  to 
the  sternum  before,  and  to  the  spine  behind.  This  mem- 
brane also  lines  the  ribs,  intercostal  muscles  and  diaphragm, 
of  that  side  of  the  thorax  to  which  it  belongs.  Above,  it 
passes  up  as  high  as  the  head  of  the  first  rib,  and  below,  it 
goes  as  low  down  as  the  last  rib.  That  part  of  the  pleura 
which  covers  the  lung,  is  the  Pleura  Pulmonalis;  that 
which  lines  the  ribs,  the  Pleura  Costalis;  and  that  covering 
the  Diaphragm,  the  Pleura  Diaphragmaticus. 

As  the  pleurae  are  bags,  like  other  serous  membranes,  and 
each  one  is  a perfect  sac,  and  as  there  is  one  on  each  side  of 
the  thorax,  it  is  very  demonstrable,  that  their  opposing  faces 
form  a septum,  which,  extends  from  the  sternum  in  front,  to 
the  spine  behind,  and  from  the  upper  part  of  the  thorax,  to  the 
diaphragm.  This  septum  is  the  Mediastinum ; and  the  heart 
is  placed  in  its  middle.  The  portion  of  the  septum  be- 
tween the  heart  and  sternum  is  the  Anterior  Mediastinum  ; 
that  between  the  heart  and  spine  is  the  Posterior  Mediasti- 
num; and  that  between  the  heart  and  the  upper  part  of  the 
thorax,  is  the  Superior  Mediastinum;  each  of  which  merits 
strict  attention. 


156 


OF  THE  TRUNK. 


An  Outline  of  a Transverse  Section  of  the  Chest,  showing  the 
relative  Position  of  the  Pleurae  to  the  Thorax  and  its  Con- 
tents. 

Fig.  37. 


1.  The  Skin  on  the  Front  of  the  Chest  drawn  up  by  a Hook. 

2.  The  Skin  on  the  Sides  of  the  Chest. 

3.  That  on  the  Back. 

4.  The  Sub-Cutaneous  Fat  and  Muscles  on  the  outside  of  the  Thorax. 

5.  Section  of  the  Muscles  in  the  Vertebral  Gutter. 

6.  Section  of  the  5th  Dorsal  Vertebra. 

7.  The  Spinal  Canal. 

8.  Spinous  Process. 

p g i 

1010  C Sections  of  the  Ribs  and  Intercostal  Muscles. 

] l.  Their  Cartilages. 

12.  The  Sternum. 

13.  The  Division  of  the  Pulmonary  Artery. 

14.  The  Exterior  Surface  of  the  Lungs. 

15.  Posterior  Face  of  the  Lungs. 

16.  Anterior  Face  of  the  Lungs. 


17. 

18. 

19. 

20. 
21. 
22. 

23. 

24. 

25. 


Inner  Face  of  the  Lungs. 

Anterior  Face  of  the  Heart  covered  by  the  Pericardium. 
Pulmonary  Artery. 

Its  Division  into  Right  and  Left  Branches. 

Portion  of  the  Right  Auricle. 

Descending  Cava  cut  off  at  the  Right  Auricle. 

Section  of  the  Left  Bronchus. 

Section  of  the  Right  Bronchus. 


VISCERA  OF  THE  THORAX. 


157 


26.  Section  of  the  (Esophagus. 

27.  Section  of  the  Thoracic  Aorta. 

The  space  between  Figures  12  and  18  and  the  two  IG's  is  the  Anterior 
Mediastinum,  and  the  space  which  contains  26  and  27  is  the  Posterior 
Mediastinum.  These  spaces  are  formed  by  the  Reflections  of  the  Pleura. 

It  is  obvious  then,  that  the  septum  consists  of  two  lami- 
nse,  one  from  each  pleura.  These  two  laminse  are  some- 
what separated,  where  they  are  called  Anterior  Mediasti- 
num, by  the  remains  of  the  thymus  gland  above,  and  by 
adipose  and  cellular  membrane  below.  The  anterior  me- 
diastinum is  attached  to  the  middle  of  the  sternum,  except 
at  its  lower  part,  where  it  inclines  somewhat  to  the  left 
side.  To  get  a good  view  of  its  contents,  the  sternum 
must  be  sawed  through  longitudinally,  and  the  two  halves 
separated  an  inch,  by  a small  block  of  wood.  The  contents 
of  the  posterior  mediastinum  and  of  the  superior,  are  best 
seen  and  understood  at  a subsequent  stage  of  the  dis- 
section. 

The  Pleura  is  a thin  and  transparent  membrane,  connected 
to  the  parts  on  which  it  lies,  by  a short  cellular  substance. 
No  red  vessels,  in  its  healthy  state,  are  to  be  observed  in  it. 
In  the  young  subject,  it  is  free  from  adeps  ; but  in  advanced 
life,  attended  with  corpulency,  considerable  masses  of  fat 
are  found  in  the  anterior  mediastinum,  and  between  it  and 
the  pericardium.  The  exhalent  vessels  of  the  pleura,  are 
derived  from  the  intercostal,  internal  mammary,  phrenic, 
and  some  other  arteries,  and  secrete  a fluid  which  lubricates 
its  surface. 

THE  PERICARDIUM. 

Between  the  pleura,  under  the  sternum,  and  reposing  on 
the  tendinous  centre  of  the  Diaphragm,  to  which  it  adheres 
by  close  cellular  substance,  is  the  Pericardium,  containing 
the  heart.  It  is  a white,  semi-transparent,  double  mem- 
brane, of  a condensed  fibrous  structure,  externally,  and 
possessed  of  little  or  no  elasticity,  which  renders  it  highly 
appropriate  for  sustaining  the  action  of  the  heart  in  its  dila- 
tations. 

Internally,  it  is  lined  by  a serous  lamina,  which  forms  a 
complete  bag,  in  being  reflected  over  the  surface  of  the 
heart,  so  as  to  give  it  an  investing  membrane.  This  invest- 


158 


OF  THE  TRUNK. 


ment  commences  at  the  back  part  or  base  of  the  heart,  and 
is  continued  over  the  whole  of  it,  being  extended  on  the 
aorta  to  the  branches  which  arise  from  the  top  of  its  curva- 
ture ; on  the  pulmonary  artery  to  its  bifurcation ; on  the 
pulmonary  veins  to  their  first  branches  ; on  the  ascending 
cava  to  the  diaphragm  ; and  on  the  descending  cava  to  the 
middle  of  the  space  between  the  entrance  of  the  vena 
azygos  and  the  transverse  vein.  The  exterior  lamina  has 
not  these  reflections,  it  is  only  united  to  the  several  parts 
where  the  reflections  commence. 

An  analogy  is  observable  in  this  arrangement  with  the 
membranes  of  the  joints ; the  exterior  lamina  of  the  peri- 
cardium corresponds  with  the  capsular  ligament,  and  the 
internal  lamina  with  the  synovial  membrane.  It  is  the  ex- 
terior membrane  which  supports  the  heart,  and  the  interior 
which  furnishes  the  lubricating  fluid,  found  in  general  in 
the  pericardium,  to  the  amount  of  a drachm.  The  fore 
part  of  the  pericardium,  lies  loosely  on  the  heart.  The  peri- 
cardium is  attached  strongly,  by  all  its  inferior  surface,  to 
the  tendon  of  the  diaphragm. 


THE  HEART. 

The  Heart  is  a hollow  muscular  organ,  consisting  of  four 
cavities,  two  Auricles  and  two  Ventricles.  Its  shape  is  some- 
what  conoidal,  but  flattened  on  the  under  surface,  which 
lies  upon  the  diaphragm.  The  base  of  the  cone  is  formed 
by  the  auricles,  the  body  by  the  ventricles,  and  the  apex  by 
the  anterior  end  of  the  left  ventricle  projecting  beyond  that  of 
the  right.  The  heart  being  fixed  as  mentioned,  between  the 
sternum  and  the  dorsal  vertebrae,  has  its  base  turned  ob- 
liquely towards  the  right  side,  while  its  apex  is  about  the 
junction  of  the  fifth  left  rib  with  its  cartilage.  Its  flat  part 
reposing  on  the  flat  tendon  in  the  centre  of  the  diaphragm, 
is  on  a horizontal  line,  or  nearly  so,  with  the  inferior  end 
of  the  second  bone  of  the  sternum.  The  heart,  in  conse- 
quence of  being  tied  down  to  the  diaphragm  by  the  peri- 
cardium, is,  excepting  its  pulsations,  exposed  to  but  little 
motion,  and  is  therefore  almost  uniformly  in  the  same  posi- 
tion. It  has,  between  the  internal  membrane  of  the  peri- 
cardium and  its  own  substance,  more  particularly  along  the 


VISCERA  OF  THE  THORAX. 


159 


course  of  the  coronary  vessels,  adipose  matter  in  great 
abundance  in  old  subjects,  and  this  adipose  matter  some- 
times penetrates  so  deeply  between  the  fasciculi  of  its  fibres, 
as  to  give  them  a very  loose  texture,  and  apparently  to  dis- 
qualify them  in  some  measure,  from  performing  their  func- 
tions. 

The  parietes  of  the  heart  are  formed  principally  of  mus- 
cular fibres,  which  are  variously  arranged ; some  pass 
spirally  around  it,  others  in  an  irregular  and  indeterminate 
manner,  but  all  in  such  a direction,  as  to  concur  by  con- 
tracting, in  effacing  its  cavities.  The  cavities  are  lined  by 
a serous  membrane,  which  is  a continuation  of,  and  resem- 
bles the  internal  coat  of  the  arteries  and  veins.  Between 
the  auricles  and  ventricles,  and  at  the  orifices  of  the  great 
arteries,  this  membrane  is  raised  up  and  reflected  so  as  to 
constitute  valves. 

The  heart  is  divided  into  Right  and  Left  sides,  each  con- 
sisting of  an  auricle  and  of  a ventricle.  The  Right  Auricle 
receives  the  two  great  trunks  of  the  venous  system,  to 
wit,  the  Ascending  and  the  Descending  Vena  Cava.  The 
Left  Auricle  receives  the  Pulmonary  Veins.  The  Right 
Ventricle  sends  off  the  Pulmonary  Artery,  and  the  Left 
Ventricle  the  Aorta. 

The  Right  Auricle,  situated  at  the  right  posterior  part  of 
the  heart,  is  an  oblong  cuboidal  cavity,  about  a line  in 
thickness.  To  view  its  internal  arrangement,  it  should  be 
slit  open  in  front  from  cava  to  cava,  we  shall  then  see  that 
its  posterior  surface  is  smooth,  and  is  formed  by  a continua- 
tion of  the  structure  of  the  great  veins,  which  meet  each 
other  at  an  obtuse  angle,  and  form  a projection  into  the 
auricles.  This  last  circumstance,  connected  with  a slight 
thickening  of  the  part,  has  given  it  the  name  of  Tuberc il- 
ium Loweri.  Anteriorly,  the  auricle  is  swelled  into  a pouch, 
(Sinus  Venosus,)  in  which  the  muscular  fibres,  instead  of 
being  uniformly  spread  into  a coat,  are  collected  into  trans- 
verse fasciculi,  lying  parallel  to  and  near  each  other;  they 
are  called  Musculi  Pectinati  from  their  resemblance  to  the 
teeth  of  a comb.  At  the  upper  part  of  the  pouch,  or  sinus, 
is  the  proper  auricular  portion  of  the  cavity,  resembling  the 
ear  of  an  animal,  whence  it  got  its  name ; it  is  not  marked 
by  any  striking  peculiarity,  except  that  the  musculi  pectinati 


160 


OF  THE  TRUNK. 


prevail  in  it.  The  auricles  have  a common  septum,  and  on 
it,  just  below  the  tuberculum  Loweri,  is  situated  the  Fossa 
Ovalis,  which  in  the  foetal  state,  was  an  opening  between  the 
auricles,  and  indeed  at  the  upper  part  of  this  depression 
we  often  find  a foramen  large  enough  to  admit  a probe  into 
the  left  auricle,  even  in  subjects  advanced  into  old  age. 
The  edges  of  the  fossa  ovalis  are  elevated  and  thickened, 
constituting  the  Annulus  Ovalis,  or  Isthmus  of  Yicussens. 

Just  below  the  fossa  ovalis,  is  the  Eustachian  Valve.  It 
is  formed  by  a duplicature  of  the  lining  membrane  of  the 
auricle  and  of  the  ascending  cava,  being  spread  somewhat 
obliquely  across  the  orifice  of  the  latter.  It  is  of  a crescentic- 
shape,  about  half  an  inch  wide,  but  occasionally  reticulated, 
and  commencing  at  the  left  side  of  the  annulus  ovalis,  ter- 
minates anteriorly,  about  the  junction  of  the  auricle  and  the 
vein.  It  is  connected  by  its  convex  edge  to  the  parietes  of 
the  auricle,  and  its  concave  or  floating  edge,  looks  some- 
what upwards.  Just  before  and  below  the  Eustachian 
valve,  is  another  much  smaller,  but  also  semilunated,  the 
Valve  of  Thebesius,  which  covers  the  orifice  of  the  great 
coronary  vein. 

Between  the  right  auricle  and  right  ventricle,  is  an  opening 
of  more  than  an  inch  in  diameter,  the  Ostium  Venosum, 
through  which  the  auricle  communicates  with  tire  ventricle. 

In  the  right  auricle,  are  many  small  orifices  of  coronary 
veins  called  F oramina  Thebesii ; they  also  exist  in  all  the 
other  cavities,  but  are  not  so  numerous  there.  They  are 
said  to  be  particularly  conspicuous  in  cases  of  diseased 
lungs. 

The  next  cavity  to  be  examined  is  the  Right  Ventricle; 
to  expose  it  satisfactorily,  it  should  be  divided  extensively 
along  the  septum  ventriculorum,  superiorly  and  inferiorly.  It 
is  of  a triangular  form,  and  its  sides  are  much  thicker  than 
the  sides  of  /the  auricle,  as  they  measure,  most  commonly, 
about  three  lines.  Its  internal  surface  is  very  irregular  and 
rough,  the  muscular  structure  of  it  being  thrown  into  pro- 
jecting columns,  the  Columnoe  Carnese,  of  very  indeterminate 
figures,  arrangement  and  dimensions.  Some  of  them  jut 
out,  and  are  connected  to  the  valve  at  the  ostium  venosum, 
by  four  or  eight  Chordse  Tendinese ; others  pass  from  one 
side  of  the  ventricle  to  the  other,  and  a third  series  presents 


VISCERA  OF  THE  THORAX. 


161 


a reticulated  appearance,  lying  on  the  face  of  the  ventricle, 
and  connected  with  it.  Their  general  object  is  to  strengthen 
the  ventricle,  to  enable  it  to  expel  its  contents,  and  to  agi- 
tate well  and  mix  the  blood. 

The  Ostium  Venosum  has  a tendinous  margin,  from 
which  is  reflected  the  lining  membrane  of  the  ventricle,  so 
as  to  form  a broad  fold,  surrounding  it.  This  fold  being 
eight  or  ten  lines  wide,  is  irregularly  divided  at  its  floating 
edge,  into  three  parts,  whence  the  name  of  Tricuspid  Valve 
has  been  given  to  it.  The  tricuspid  valve,  is  situated  in 
the  right  ventricle,  has  its  loose  margin  attached  to  the  round 
tendinous  chords  just  mentioned,  called  the  Chordae  Ten- 
dineae,  which  again  arise,  from  the  Columns  Carnes.  These 
tendinous  attachments  of  the  tricuspid  valve,  prevent  it 
from  being  thrown  into  the  auricle,  when  the  ventricle  con- 
tracts. 

At  the  upper  part  of  the  ventricle  is  the  orifice  of  the  pul- 
monary artery,  which  conveys  the  blood  to  the  lungs ; pro- 
vision for  it  is  made  by  the  upper  part  of  the  ventricle  be- 
coming smooth.  The  orifice  of  the  artery  is  round,  and 
about  twelve  lines  in  diameter.  From  the  internal  surface 
of  the  artery,  a little  beyond  its  orifice,  three  valves  arise, 
called  Semilunar,  which  may  be  compared,  each  to  a semi- 
circular plane,  connected  by  its  circumference  to  a cylin- 
drical cavity.  The  diameter  of  the  plane  is  loose  ; in  the 
centre  of  it,  is  a small  cartilaginous  body,  the  Corpusculum 
Aurantii;  and  on  each  side  of  the  corpusculum,  the  diame- 
ter of  the  valve,  instead  of  being  a straight  line,  is  slightly 
festooned.  The  valve  is  almost  diaphanous,  and  seems  to 
be  produced  by  a reflection  of  the  lining  membrane  of  the 
artery.  Between  the  coats  of  this  reflection,  is  however,  to 
be  found  another  substance  very  much  like  that  of  the  ar- 
tery, which  also  forms  a festooned  edge  a little  below  the 
one  just  described.  As  the  three  valves  are  placed  in  a row 
surrounding  the  artery,  in  its  action  they  are  thrown  down, 
forming  thereby  a complete  septum  against  the  return  of 
the  blood  into  the  ventricle  ; and  the  Corpuscula  Aurantii 
being  in  the  middle  of  each,  form  a point  of  support  or 
abutment,  at  which  the  edges  of  the  valves  sustain  each 
other.  Between  the  outer  face  of  the  valve  and  the  in- 
ternal face  of  the  artery,  a pocket  attended  with  a dila- 
11 


162 


OF  THE  TRUNK. 


tation  of  the  artery  is  formed,  called  the  Sinus  of  Val- 
salva. 

The  Pulmonary  Artery,  is  a large  white  fibrous  tube 
given  off  in  the  manner  mentioned ; under  the  arch  of  the 
aorta,  it  divides  into  two  branches,  right  and  left,  which  go 
to  the  lungs  of  their  respective  sides.  The  right  branch  is 
the  larger  of  the  two,  and  passing  under  the  arch,  is  then 
minutely  distributed  to  its  lung.  The  left,  is  in  front  of  the 
descending  aorta,  and  is  distributed  to  the  left  lung  with 
equal  minuteness. 

These  trunks  separate  widely,  and  from  the  middle  of 
their  fork,  proceeds  a ligamentous  substance,  the  remains  of 
the  Ductus  Arteriosus  of  the  fcetus,  to  the  aorta,  posteriorly 
to  the  origin  of  the  left  subclavian  artery. 

The  blood  is  brought  from  the  lungs,  by  the  pulmonary 
veins,  which  are  four  in  number,  two  on  each  side.  The 
branches  constituting  the  trunk  of  each  of  these  veins,  are 
generally  united  before  the  trunk  penetrates  the  pericardium. 
This  trunk,  afterwards  unites  with  the  auricle  at  one  of  its 
corners. 

The  Left  Auricle,  has  about  the  same  cubic  capacity  with 
the  right,  but  differs  from  it  somewhat  in  its  figure,  in  being 
more  square.  Its  broad  internal  surface  looks  towards  the 
spine.  It  is  fixed  to  the  posterior  part  of  the  left  ventricle, 
and  is  divided  like  the  right  auricle,  into  the  Sinus  Venosus, 
sometimes  called  Sinus  Pulmonalis,  and  into  the  Proper 
Auricle.  The  latter  is  situated  at  the  left  side  of  the  pul- 
monary artery,  and  is  somewhat  longer,  narrower,  more 
crooked,  and  more  notched  at  its  margins  than  the  other 
proper  auricle.  When  the  left  auricle  is  cut  open,  which 
should  be  done  by  a slit  down  its  middle,  it  will  be  per- 
ceived that  its  parietes  are  thicker  than  those  of  the  right, 
and  that  both  externally  and  internally,  its  surfaces  are 
perfectly  smooth,  except  in  the  proper  auricular  part,  where 
the  Musculi  Pectinati  prevail. 

The  Septum  between  the  auricles,  viewed  on  this  side, 
is  smooth,  not  presenting  any  remarkable  appearance ; when 
held  up  to  the  light,  it  is  seen  to  be  thinner  and  more  trans- 


VISCERA  OF  THE  THORAX. 


163 


parent  at  the  place  corresponding  with  the  fossa  ovalis  of 
the  other  side.  At  the  anterior  and  inferior  side  of  the  au- 
ricle, is  the  ostium  venosum,  communicating  with  the  left 
ventricle ; it  has  a tendinous  margin,  and  is  rather  more 
than  an  inch  in  diameter. 

The  Left  V entricle  differs  from  the  right  in  shape,  in  being 
more  conical,  but  it  is  equally  capacious.  Its  anterior  part 
constitutes  the  apex  of  the  heart,  and  strikes  against  the 
ribs.  The  best  mode  of  examining  its  cavity,  is  to  make 
an  incision  through  its  parietes  near  the  septum,  and  to  se- 
parate it  completely  on  that  side  from  its  fellowr.  Another 
incision  should  be  made  so  as  to  detach  it  from  the  auricle, 
also  near  its  septum.  The  latter  cut  is  to  be  executed  with 
particular  care,  so  as  to  avoid  wounding  the  interior  struc- 
ture. That  done,  we  see  its  general  arrangement  within, 
corresponding  with  the  right  ventricle.  Its  parietes  are 
eight  lines  through,  being  about  three  times  as  thick  as  the 
other.  Its  columnse  carnese  are  larger  and  stronger,  but 
arranged  on  the  same  principle,  some  passing  from  side  to 
side  of  the  cavity,  others  being  reticulated  and  easily  raised 
up  from  the  part  of  the  ventricle  on  which  they  lie,  and 
a third  set  aiding  the  valvular  apparatus  at  the  ostium  ve- 
nosum. 

The  Mitral  Valve  exists  at  the  left  ostium  venosum,  and 
is  formed  by  a duplicature  of  the  lining  membrane  of  this 
ventricle.  It  is  partially  divided  into  two  parts,  which  are 
pointed  at  their  edges.  Its  columnse  carnese  are  numerous 
and  strong,  and  its  chordse  tendinse  are  of  corresponding 
characters.  The  mitral  valve  prevents  the  regurgitation  of 
blood  into  the  left  auricle,  and  is  so  placed,  that  the  upper 
half  of  it,  when  the  blood  is  rushing  into  the  ventricle,  con- 
ceals the  orifice  of  the  aorta. 

Towards  the  orifice  of  the  aorta,  which  is  at  the  posterior 
superior  part  of  the  ventricle,  the  surface  of  this  cavity  is 
smooth,  to  facilitate  the  passage  of  blood.  The  septum  be- 
tween the  ventricles  is  of  the  same  thickness  with  the  left 
ventricle ; it  is  formed  partly  by  the  right  ventricle,  but 
principally  by  the  left. 

The  Mouth  of  the  Aorta  is  about  an  inch  in  diameter, 
and  is  furnished  with  three  Semilunar  Valves,  Corpuscula 


164 


OF  THE  TRUNK. 


Aurantii,  and  Sinuses  of  Valsalva,  after  the  same  manner 
with  the  pulmonary  artery,  so  that  the  description  of  one, 
will  suit  the  other,  with  the  addition,  that  those  parts  of  the 
aorta  are  stronger  and  more  developed.  ‘ The  coats  of  the 
aorta  are  nearly  three  times  as  thick  as  those  of  the  pulmo- 
nary artery,  to  qualify  it  for  bearing  the  increased  pressure 
of  the  blood.  The  aorta  is  dilated  shortly  after  its  com- 
mencement, so  as  to  form  the  large  Sinus  of  Valsalva.  The 
aorta  lies  first  at  the  back  of  the  pulmonary  artery,  it  then 
gets  to  its  right,  being  between  it  and  the  superior  vena 
cava;  part  of  it  is  there  to  the  right  of  the  spine,  it  then 
makes  its  arch,  which  brings  it  to  the  left  of  the  spine,  and 
in  contact  with  it  about  the  third  dorsal  vertebra.  The  su- 
perior part  of  its  arch,  is  about  eight  lines  below  the  upper 
edge  of  the  sternum. 

The  heart  being  a mere  machine  for  propelling  blood, 
requires  another  source  for  its  nourishment  besides  the  fluid 
circulating  through  its  great  cavities  ; this  is  furnished  by 
the  Coronary  Arteries,  which  are  two  in  number.  The 
first,  called  Right  Coronary,  becomes  visible  between  the 
pulmonary  artery  and  the  right  auricle,  and  passing  on  the 
septum  between  the  right  auricle  and  ventricle,  extends 
around  the  heart  to  its  flat  side,  distributing  to  the  conti- 
guous parts,  branches  which  for  the  most  part,  pass  off  at 
right  angles.  The  second,  or  Left  Coronary  Artery,  appears 
between  the  pulmonary  artery  and  the  left  auricle ; before 
it  has  become  very  obvious,  it  divides  into  two  branches, 
one  passes  on  the  septum  ventriculorum  to  the  apex  of  the 
heart ; the  other  winds  on  the  septum  between  the  left  auri- 
cle and  the  left  ventricle,  and  some  of  its  branches  pass  on 
the  flat  surface  of  the  heart  to  its  apex. 

The  Coronary  Veins  receive  the  blood  of  the  coronary 
arteries ; a common  trunk  is  formed  by  them,  which  passes 
for  some  distance  on  the  septum,  between  the  left  auricle 
and  ventricle,  and  then  opens  into  the  right  auricle  just 
anterior  to  the  Eustachian  Valve,  at  the  spot  already  indi- 
cated. 


VISCERA  OF  THE  THORAX. 


165 


OF  THE  LUNGS. 

The  Lungs  are  of  a bluish  colour,  and  occupy  by  far  the 
greater  part  of  the  cavity  of  the  thorax ; they  are  two  dis- 
tinct bodies,  placed  one  at  either  side  of  the  heart,  from 
which  circumstance,  they  are  divided  into  right  and  left 
lung.  Their  external  shape  and  dimensions,  with  an  in- 
considerable exception,  are  the  same,  as  they  correspond  in 
their  periphery  with  the  symmetrical  sides  of  the  thorax. 
The  apex  of  the  heart,  from  being  pushed  into  the  lung  of 
the  left  side,  gives  its  surface  towards  the  mediastinum,  a 
somewhat  different  figure  from  the  lung  of  the  right  side ; 
the  left  lung  is  also  the  smaller. 

To  appreciate  the  extent  and  form  of  the  lung,  it  must 
be  recollected,  that  the  cavity  of  the  thorax  is  much  deeper 
behind  than  it  is  before.  The  vertical  diameter  before, 
amounts  only  to  the  length  of  the  two  upper  bones  of  the 
sternum,  whereas  the  same  diameter  behind,  is  the  whole 
length  of  the  column  formed  by  the  dorsal  vertebrae.  The 
figure  of  each  lung  is  also  modified  by  the  convexity  of  the 
diaphragm;  for  this  body,  extending  from  the  lower  point 
of  the  dorsal  vertebrae  obliquely  upwards  to  the  end  of  the 
second  bone  of  the  sternum,  would,  if  it  were  only  a plain 
surface,  influence  the  contiguous  faces  of  the  lungs,  so  as  to 
make  them  resemble  when  united,  the  inferior  part  of  an 
ox’s  hoof;  but  this  resemblance  is  much  increased  by  the 
diaphragm  forming  a convexity  towards  the  thorax,  which, 
rises  much  above  what  its  plane  would.  The  similitude  of 
the  lungs  to  the  ox’s  hoof,  with  the  back  part  foremost,  is 
therefore  sufficiently  exact  for  anatomical  comparison,  and 
particularly,  as  it  regards  their  inferior  surface. 

The  lung  lies  loose  every  where,  except  at  the  surface 
corresponding  to  the  side  of  the  basis  of  the  heart ; here  it 
is  attached  to  the  heart  by  the  pulmonary  veins,  pulmonary 
artery,  and  by  a branch  of  the  trachea.  These  tubes  con- 
stitute the  Root  of  the  Lung,  and  over  the  root,  is  reflected 
the  pleura,  from  the  pericardium.  The  pleura  which  covers 
the  root  of  the  lung,  is  extended  downwards,  under  the  name 
of  Ligamentum  Pulmonis,  and  serves  to  fix  the  posterior 
edge  of  the  lung  to  the  pericardium,  as  low  down  as  the 
diaphragm. 


166 


OF  THE  TRUNK. 


The  Right  Lung,  is  divided  by  an  oblique  and  a horizontal 
fissure  passing  from  it,  into  three  lobes — the  Left  Lung,  has  a 
single  oblique  fissure  dividing  it  into  two  lobes.  Each  lobe 
consists  of  a multitude  of  lobules  adhering  laterally  by  cel- 
lular substance : and  each  lobule  is  formed  of  a congeries 
of  air  vesicles,  which  communicate  freely  through  their  sides 
from  the  imperfection  of  the  latter,  though  the  cells  of  diffe- 
rent lobules  do  not  communicate. 

The  parietes  of  the  air  vesicles  are  of  extreme  tenuity, 
and  have  the  pulmonary  artery  and  vein  ramifying  with  ex- 
ceeding minuteness  on  them  for  the  purpose  of  respiration. 

The  lung  of  the  bullock,  exhibits  the  structure  better  than 
that  of  the  human  lung,  by  a little  tearing  of  the  parts 
asunder.  The  lobuli  are  also  well  seen  in  the  foetus,  and 
in  very  young  subjects. 

The  Trachea,  the  bifurcation  of  which  forms  the  Bron- 
chiae,  is  an  almost  cylindrical  tube,  which  passes  in  front  of 
the  oesophagus  and  of  the  vertebra,  from  the  inferior  part 
of  the  larynx,  to  the  third  dorsal  vertebrae;  it  there  divides 
into  the  Bronchiae,  and  is  placed  between  the  pleurae  of  the 
two  sides  of  the  thorax.  The  right  Bronchia  is  shorter, 
larger,  and  less  slanting  than  the  left ; it  sinks  below  the 
pulmonary  artery,  and  penetrates  the  lung  opposite  to  the 
fourth  dorsal  vertebra ; the  left  being  long  and  narrow,  en- 
ters the  lung  below  the  pulmonary  artery,  opposite  to  the 
fifth  dorsal  vertebra.  The  bronchiae  then  divide  and  sub- 
divide through  the  structure  of  the  lung,  till  the  ultimate 
extremities  terminate  in  the  air  vesicles. 

The  Trachea  preserves  its  cylindrical  shape,  and  is  kept 
open,  by  a cartilaginous  structure,  which  is  composed  of 
from  sixteen  to  twenty  pieces,  more  or  less  distinct  from 
each  other.  Thus  arranged,  the  cartilages  form  about  two- 
thirds  of  the  circumference  of  a circle,  occupying  the  front 
of  the  trachea,  and  giving  it  the  appearance,  anteriorly,  of 
a cartilaginous  tube.  The  remaining  third  is  membranous. 
The  cartilages  of  the  trachea  are  deposited  in  a kind  of 
perichondrium,  possessed  of  extreme  elasticity,  which  has 
continually  a tendency  to  approximate  the  cartilages,  and  is 
resisted  only  by  the  attachments  of  the  two  extremities  of 
the  trachea.  The  effect  of  this  elasticity,  is  demonstrated 
in  the  living  body  by  attempts  at  suicide,  where  the  trachea 


VISCERA  OF  THE  THORAX. 


167 


being  cut  through,  so  great  a gap  is  made  in  the  throat,  that 
it  presents  the  appearance  of  a part  having  been  removed. 
The  deficiency  at  the  back  part  of  the  cartilages,  is  filled 
up  by  a condensed  cellular  substance  in  continuation  with 
this  elastic  membrane.  Transverse  muscular  fibres  are 
placed  between  the  extremities  of  the  cartilages,  and  by  their 
contractions,  bring  them  towards  each  other : according  to 
the  opinion  of  the  late  Dr.  Physick,  by  diminishing  the  size 
of  the  trachea,  they  assist  in  the  expulsion  of  mucus.  A con- 
tinuation of  the  mucous  membrane  of  the  Pharynx  and 
Larynx,  lines  the  trachea  ; it  is  studded  with  a great  number 
of  follicles  which  secrete  mucus.  Under  the  membrane  are 
many  glands,  from  the  size  of  a millet-seed  to  that  of  the 
head  of  a small  pin,  and  which  have  their  excretory  tubes 
terminating  in  the  trachea.  These  glands  are  also  abundant 
on  the  posterior  face  of  the  transverse  muscular  fibres. 

The  Bronchite,  in  dividing,  still  preserve  for  some 
length,  the  cartilaginous  structure  of  the  trachea,  but  as  they 
approach  their  terminations,  the  deficiency  at  their  back 
part  ceases,  and  the  cartilages  form  sections  of  circles,  which 
produce,  by  the  apposition  of  several  of  them,  complete 
cylinders.  This  arrangement  holds  till  finally  the  cartila- 
ginous structure  ceases,  and  only  membrane  is  left.  It  is 
probable,  from  the  elasticity  of  the  lung,  and  from  its  col- 
lapsing when  the  thorax  is  opened,  that  the  elastic  mem- 
brane, in  which  the  cartilages  are  deposited,  forms  the 
essential  cellular  structure  of  this  organ  on  which  the  blood 
vessels  are  ramified. 

At  the  lower  end  of  the  trachea,  and  about  the  root  of 
the  lungs,  is  found  the  commencement  of  a chain  of  lym- 
phatic glands,  which  follow  for  some  distance,  the  bronchiae. 
In  the  adult  they  are  black,  numerous,  and  vary  from  the 
dimension  of  a large  pin’s  head  to  that  of  a kidney  bean. 

The  lungs  are  furnished  from  the  aorta  with  nutritious 
vessels,  called  Bronchial  Arteries.  They  follow  the  course 
of  the  bronchiae  and  communicate  freely  with  the  pulmonary 
arteries ; notwithstanding,  they  have  their  proper  veins, 
which  empty  on  the  right  side,  into  the  vena  azygos,  and 
on  the  left  into  the  subclavian  vein.  The  bronchial  veins 
also  communicate  freely  with  the  pulmonary  veins. 


168 


OF  THE  TRUNK. 


The  Larynx,  Trachea  and  Bronchia,  deprived  of  their  Fibrous 
Covering;  with  the  outline  of  the  Lungs. 


Fig.  38. 


LI.  Outline  of  the  Upper  Lobe  of  the  Lungs. 

2.  Outline  of  the  Middle  Lobe  of  the  Right  Lung. 

3.3.  Outline  of  the  Inferior  Lobe  of  both  Lungs. 

4.  Outline  of  the  9th  Dorsal  Vertebra,  showing  its  relation  to  the 

Lungs  and  the  Vertebral  Column. 

5.  Thyroid  Cartilage. 

6.  Cricoid  Cartilage. 

7.  Trachea. 

8.  Right  Bronchus. 

9.  Left  Bronchus. 

10.  Crico-Thyroid  Ligament. 

11.12.  Rings  of  the  Trachea. 

13.  First  Ring  of  the  Trachea. 

14.  Last  Ring  of  the  Trachea,  which  is  Corset-shaped. 


VISCERA  OF  THE  THORAX. 


169 


15.16.  A complete  Bronchial  Cartilaginous  Ring. 

17.  One  which  is  Bifurcated. 

18.  Double  Bifurcated  Bronchial  Rings. 

19.19.  Smaller  Bronchial  Rings. 

20.  Depressions  for  the  course  of  the  large  Blood-Vessels. 


While  studying  the  contents  of  the  thorax,  it  is  of  the 
first  importance  to  attend  to  the  relative  situation  of  the 
parts  included  in  the  description.  One  of  the  most  use- 
ful and  interesting  points,  is  the  space  between  the  two 
upper  ribs,  bounded  laterally  by  the  pleurae,  anteriorly  by 
the  sternum,  posteriorly  by  the  upper  dorsal  vertebrae,  and 
having  the  top  of  the  pericardium  for  its  basis.  This  cavity 
is  too  irregular  to  admit  of  comparison  with  any  thing  else, 
without  a hazard  of  communicating  false  ideas  of  its  shape. 
The  course  of  the  pleura  on  each  side,  must  be  well  attended 
to,  and  in  order  to  understand  it,  the  obliquity  of  the  first 
rib  must  be  taken  into  consideration.  Considering  the 
spine  as  a vertical  column,  the  first  rib,  so  far  from  being 
horizontal,  is  in  a majority  of  subjects,  inclined  down- 
wards so  much,  that  it  makes  an  angle  of  about  forty-five 
degrees  with  the  spine  ; and  the  pleura  being  reflected 
from  the  internal  edge  of  the  first  rib,  from  its  head  to  its 
front  part,  will  of  course  observe  a similar  obliquity.  It 
is  probably  this  circumstance,  which  Sabatier,  Soemmering 
and  Codes  allude  to,  when  they  speak  of  the  pleura  rising 
above  the  level  of  the  first  rib.  This  arrangement  should 
influence  the  considerations  arising  from  a wound  in  the 
lower  part  of  the  neck,  as  a ball  or  sword  passing  through 
horizontally  just  above  the  sternal  end  of  the  clavicle,  would 
certainly  enter  the  cavity  of  the  pleura  in  a great  number  of 
persons. 

In  the  upper  section  of  the  mediastinum,  just  at  the 
upper  edge  of  the  sternum,  are  the  remains  of  the  Thymus 
Gland,  much  shrivelled,  having  a ligamentous  feel,  and  of 
a light  pink  colour.  In  contact  with  the  pleura  on  the  right 
is  the  Descending  Vena  Cava.  The-  common  trunk  of  the 
left  subclavian  and  internal  jugular  veins,  (Vena  Innomi- 
nata,)  after  crossing,  by  an  oblique  descent,  the  Upper  por- 
tion of  the  sternum,  joins  the  descending  vena  cava  about 
an  inch  above  the  place  where  the  latter  penetrates  into  the 
pericardium.  Behind  this  transverse  vein,  are  the  top  of  the 
arch  of  the  Aorta,  the  origin  of  the  Arteria  Innominata,  the 


170 


OF  THE  TRUNK. 


Left  Carotid,  and  the  Left  Subclavian  Artery.  The  oesopha- 
gus makes  a vertical  descent  just  before  the  dorsal  verte- 
brae; the  trachea  is  placed  before  it,  and  we  see  the  arteria 
innominata,  crossing  the  latter  obliquely  from  left  to  right. 
The  arteria  innominata  is  placed  much  more  superficially 
than  the  left  subclavian,  being  removed  from  the  upper  end 
of  the  sternum,  only  by  the  thickness  of  the  transverse  vein, 
and  is  very  accessible,  whereas  the  other,  being  the  last 
branch  given  off  from  the  curve  of  the  aorta  in  its  course 
backwards,  is  an  inch  deeper,  and  extremely  difficult  of 
access  in  the  living  body.  The  arteria  innominata  varies 
much  in  length,  before  its  division  into  subclavian  and  caro- 
tid. I have  examples  of  it  from  half  an  inch  to  two  inches, 
but  the  general  length  is  about  sixteen  lines. 

In  this  dissection,  the  phrenic  nerve  is  seen  to  descend  in 
contact  with  the  internal  edge  of  the  scalenus  anticus  mus- 
cle, and  passing  between  the  subclavian  artery  and  vein,  to 
proceed  vertically  in  contact  with  the  pleura  at  first,  and  af- 
terwards between  it  and  the  pericardium,  to  the  diaphragm. 
The  par  vagum  is  on  the  inner  side  of  the  internal  jugular 
vein,  and  gets  into  the  thorax,  between  the  subclavian  ar- 
tery and  vein,  near  the  origin  of  the  subclavian  artery. 
The  trunk  of  it  passes  along  the  side  of  the  trachea,  and 
behind  the  root  of  the  lungs  to  the  oesophagus,  and  termi- 
nates at  the  stomach.  On  a level  with  the  subclavian  ar- 
tery, the  Recurrent  or  Inferior  Laryngeal  Nerve  is  sent  off, 
which  to  get  to  the  larynx,  winds  around  the  subclavian  of 
the  right,  and  the  aorta  on  the  left  side.  About  the  root  of 
the  lungs,  the  Pulmonary  Plexus  is  detached  from  the  Par 
Vagum  nerve.  The  Sympathetic  Nerve  lies  closer  to  the 
vertebrae,  and  sends  off  from  its  two  inferior  cervical  gan- 
glions principally,  the  branches  which  supply  the  heart,  by 
the  cardiac  plexus.  In  the  thorax  it  continues  its  course 
by  the  heads  of  the  ribs,  and  sending  off  the  greater  and 
lesser  Splanchnic  nerves,  is  distributed  in  a manner  to  he 
described  hereafter. 

In  making  this  dissection,  it  must  be  observed  that  from 
the  lower  part  of  the  thyroid  gland,  tire  condensed  mem- 
brane called  Fascia  Profunda  Cervicis,  which  seems  to 
afford  protection  to  the  upper  opening  of  the  thorax 
and  is  extended  to  the  upper  edge  of  the  sternum,  has  be- 
beneath  it,  connecting  the  vessels  and  other  parts  together, 


VISCERA  OF  THE  THORAX. 


171 


a loose,  vascular,  adipose,  and  cellular  matter,  which 
must  be  removed  by  dissection,  before  the  rest  of  the  struc- 
ture can  be  rendered  distinct.  The  plan  for  opening  the 
thorax,  by  the  sternum  being  sawed  in  two  longitudinally, 
and  kept  open  to  the  distance  of  an  inch  or  so,  is  by  far 
the  most  exact  and  satisfactory  manner  of  studying  these 
parts. 

This  stage  of  the  dissection  having  been  accomplished, 
the  sternum  must  be  removed,  and  by  turning  up  the  lungs, 
we  see  the  parts  contained  in  the  posterior  mediastinum 
and  what  is  meant  by  it.  To  the  left  is  the  Aorta,  which 
gradually  gets  to  the  front  of  the  dorsal  vertebrae  in  the 
lower  part  of  the  thorax,  as  it  penetrates  the  crura  of  the 
diaphragm.  The  (Esophagus  is  in  the  middle  above,  but 
in  getting  to  its  own  opening  in  the  diaphragm,  it  crosses 
the  aorta  very  obliquely,  and  is  then  to  the  left  of  the  lower 
dorsal  vertebrae.  The  Vena  Azygos,  made  up  of  the  six 
lower  intercostal  veins  on  the  left  side,  and  the  ten  lower 
of  the  right,  occupies  the  right  side  of  the  mediastinum, 
and  forms  an  arch  at  its  termination  where  it  joins  the  de- 
scending cava,  over  the  root  of  the  right  lung.  The  Tho- 
racic Duct  enters  the  thorax  between  the  crura  of  the  dia- 
phragm, and  passes  nearly  in  the  middle  line  between  the 
aorta  and  the  vena  azygos,  till  it  reaches  the  third  dorsal 
vertebra;  it  then  inclines  to  the  leftside,  and  rising  into  the 
root  of  the  neck,  forms  an  arch  which  terminates  in  the 
angle  produced  by  the  conjunction  of  the  left  internal  jugu- 
lar and  subclavian  vein.  The  Par  Vagum  is  strictly  within 
the  limits  of  the  posterior  mediastinum,  the  Sympathetic 
is  not. 


PART  II 


CHAPTER  II. 

OF  THE  ABDOMEN. 

Before  the  commencement  of  the  dissection  of  the  Ab- 
domen, it  is  useful  to  acquire  a knowledge  of  its  regions, 
the  boundaries  of  which  are  thus  established  by  imaginary 
planes  passing  through  the  subject.  Draw  a line  from  the 
superior  part  of  the  Crista  of  one  Ilium,  as  it  appears  through 
the  skin,  to  the  superior  part  of  the  other ; strike  a perpen- 
dicular then,  from  the  anterior  inferior  spinous  process  of 
the  ilium  on  each  side,  through  the  cartilages  of  the  ribs 
above;  then  draw  a fourth  line  parallel  with  the  first, 
through  the  points  where  the  latter  touch  the  cartilages  of 
the  ribs.  These  four  lines,  two  vertical  and  two  horizon- 
tal, which  represent  as  many  planes  intersecting  the  abdo- 
men, form  with  the  periphery  of  the  abdomen,  nine  regions. 
The  one  above,  on  the  right,  is  the  Right  Hypochondriac, 
that  in  the  middle,  the  Epigastric,  and  that  to  the  left,  the 
Left  Hypochondriac.  The  region  which  has  the  navel  in 
its  centre  is  the  Umbilical,  and  on  its  sides  are  the  Right 
and  the  Left  Lumbar  Region.  Below  the  umbilical  is  the 
Hypogastric  Region,  and  on  the  wings  of  the  latter  are  the 
Plight  and  the  Left  Iliac  Region. 

Some  anatomists  call  the  pit  around  the  ensiform  carti- 
lage, the  Scrobiculus  Cordis,  and  a small  space  just  behind 
and  elevating  itself  about  an  inch  above  the  pubis,  the  Re- 
gio  Pubis.  The  boundaries  of  the  latter  are  rather  unde- 
fined, but  the  terms  are  in  use. 


174 


OF  THE  TRUNK. 


A View  of  the  External  Parietes  of  the  Abdomen,  with  the 

POSITION  OF  THE  LINES  DRAWN  TO  MARK  OFF  ITS  REGIONS. 

Fig.  39. 


1.1.  A line  drawn  from  the  highest  point  of  one  Ilium  to  the  same 

point  of  the  opposite  one. 

2.2.  A line  drawn  from  the  Anterior  Superior  Spinous  process  to  the 

Cartilages  of  the  Ribs. 

3.3.  A similar  one  foi  the  opposite  side. 

4.4.  A line  drawn  perpendicularly  to  these,  and  touching  the  most  pro- 

minent  part  of  the  Costal  Cartilages,  thus  forming  nine  regions. 

5.5.  The  Right  and  Left  Hypochondriac  Regions. 

6.  The  Epigastric  Region. 

7.  The  Umbilical  Region. 

8.8.  The  Right  and  Leit  Lumbar  Regions. 

9.  The  Hypogastric  Region. 

10.10.  The  Right  and  left  Iliac  Regions. 

11.  The  lower  part  of  the  Hypogastric,  sometimes  called  Pubic. 


MUSCLES  OF  THE  ABDOMEN. 


175 


SECTION  I. 


Of  the  Muscles  of  the  Abdomen. 

To  begin  the  dissection  of  the  muscles  of  the  abdomen, 
a straight  cut  must  be  made  through  the  skin  from  the  end 
of  the  second  bone  of  the  sternum,  to  the  symphysis  pubis  ; 
another  is  to  cross  this  at  its  commencement  above,  ex- 
tending obliquely  towards  the  armpit,  till  it  reaches  the  side 
of  the  chest.  The  second  terminates  and  a third  com- 
mences there,  having  a sweep  backwards,  parallel  in  its 
direction  with  the  margin  of  the  cartilages  of  the  ribs,  and 
equidistant  from  it.  The  third  cut  by  being  extended  to 
the  spine,  affords  an  opportunity  of  opening  the  integuments 
still  farther,  by  a vertical  cut  over  the  spinous  processes 
down  to  the  small  end  of  the  sacrum.  This  manner  of 
opening  the  integuments  of  the  side  of  the  belly,  describes 
in  a great  measure  the  outline  of  the  external  oblique  mus- 
cle, makes  it  thoroughly  accessible  in  the  progress  of  the 
dissection,  and  enables  one  to  see  and  to  display  every 
part  of  it.  One  of  the  greatest  obstacles  to  understanding 
the  broad  muscles  of  the  abdomen  well,  simple  as  the  cir- 
cumstance may  appear,  is  the  imperfect  manner  in  which 
the  integuments  are  opened  by  dissectors:  and  there  is  no 
dissection  more  apt  to  be  spoiled,  than  the  one  in  which 
we  are  now  engaged,  owing  to  the  want  of  a plan,  founded 
on  some  previous  knowledge  of  the  parts,  for  commencing 
operations.  Having  thus  marked  off  the  section  of  the  sub- 
ject on  which  to  work,  begin  by  dissecting  at  the  upper 
oart,  to  turn  the  flap  of  common  integuments  downwards. 
But  few  strokes  of  the  knife  will  be  made,  before  the  up- 
oer  fibres  of  the  external  oblique  muscle  will  be  exposed. 
The  flap  is  now  to  be  entirely  dissected  off  as  far  down  as 


176 


OF  THE  TRUNK. 


the  hip  and  thigh,  exposing,  by  such  means,  the  superior 
margin  of  the  pelvis,  from  the  spine  to  the  symphysis  pu- 
bis. The  beginner  must  cut  very  slowly,  seeing  that  he 
detaches  fully  the  cellular  membrane  from  the  muscular 
fibres;  by  cutting  in  the  same  direction  with  the  latter,  he 
will  leave  them  clean  and  brilliant,  and  the  transition  to 
the  broad  tendon  connected  with  them,  will  be  comparative- 
ly easy. 

In  this  dissection,  as  indeed  in  all  others  of  the  muscles,  I 
cannot  attach  too  much  importance  to  cutting  parallel  with 
the  fibres;  it  is  absolutely  essential  to  the  beauty  of  the  dis- 
play, and  indispensable  to  a person  desirous  of  success  in 
practical  anatomy.  A dissection  done  in  any  other  man- 
ner, is  unfit  for  study  from  its  obscurity,  and  offensive  to 
inspect,  from  its  roughness.  The  sum  of  directions  to  make 
a good  dissector  of  muscles,  is,  to  cut  in  the  line  of  the 
fibres,  close  to  them,  and  to  keep  the  cellular  membrane 
tense. 

There  are  five  pairs  of  muscles  to  the  abdomen,  three 
broad  and  two  narrow,  to  wit,  the  Obliquus  Externus,  the 
Obliquus  Internus,  the  Transversalis,  the  Rectus,  and  the 
Pyramidalis. 

In  the  middle  line  of  the  body,  the  tendons  of  the  three 
broad  muscles  on  each  side  of  the  abdomen  unite  to  form 
the  Linea  Alba,  wTbich  extends  from  the  sternum  to  the 
pubes.  From  two  to  three  inches  in  the  adult,  on  each  side 
of  the  linea  alba,  but  more  distant  from  it  above  than  be- 
low, is  another  line  formed  by  the  same  tendons,  which  is 
the  Linea  Semilunaris.  The  navel,  which  originally  was  a 
hole  for  the  passage  of  the  umbilical  vessels,  and  in  the 
adult  is  commonly  depressed  into  a pit,  now  appears  in  the 
linea  alba  as  a protuberance  composed  of  condensed  cellular 
membrane.  Just  at  the  navel,  there  is  a line  crossing  the 
linea  alba,  and  extending  from  one  linea  semilunaris  to  the 
other.  At  the  lower  end  of  the  Cartilago  Ensiformis,  there 
is  another,  and  half-way  between  this  and  the  navel,  a third. 
About  half  way  between  the  navel  and  the  pubes  is  a 
fourth,  but  it  is  generally  imperfect.  These  are  the  Lines 


MUSCLES  OF  THE  ABDOMEN. 


177 


Transvers®,  and  they  are  formed  by  tendinous  matter  in 
the  substance  of  the  Recti  muscles,  connecting  them  to  their 
tendinous  sheath  in  front. 

1.  The  Musculus  Obliquus  Externus,  arises  from  the 
eight  inferior  ribs,  by  muscular  and  tendinous  digitations 
attached  near  their  anterior  extremities.  The  first  head  is 
covered  by  a slip  from  the  pectoralis  major,  the  five  upper 
heads  are  interlocked  with  the  origins  of  the  serratus 
major  anticus,  and  the  three  inferior,  with  the  latissimus 
dorsi.  The  fibres  pass  obliquely  downwards,  and  termi- 
nate in  a broad  thin  tendon.  This  tendon  extends  over 
the  whole  front  of  the  abdomen,  from  the  lower  end  of  the 
second  bone  of  the  sternum,  to  the  symphysis  of  the 
pubes. 

It  is  inserted  by  its  tendon  into  the  'whole  length  of  the 
linea  alba,  and  into  the  anterior  half  or  two-thirds  of  the  crista 
of  the  ilium,  by  muscular  fibres  posteriorly,  and  tendinous 
anteriorly.  It  is  also  to  be  observed,  that  from  the  anterior 
superior  spinous  process,  the  tendon  stretches  to  the  body 
and  symphysis  of  the  pubes,  forming  thereby  the  Ligament  of 
Poupart,  or  the  Crural  Arch.  As  this  ligament  approaches 
the  pubes  from  the  ilium,  it  splits  so  as  to  leave  a hole  for 
the  passage  of  the  Spermatic  Cord  in  the  male,  and  of  the 
Round  Ligament  of  the  Uterus  in  the  female.  This  open- 
ing is  named  the  External  Abdominal  Ring.  The  tendon 
forming  its  upper  boundary,  is  inserted  into  the  symphysis 
pubis,  and  into  the  pubes  of  the  opposite  side,  by  fibres 
which  are  interwoven  with  and  decussate  those  of  its  fel- 
low. The  tendon  forming  the  lower  margin  of  the  ring,  is 
inserted  into  the  spine  of  the  pubes,  and  into  its  crista,  for 
an  inch.  The  portion  inserted  into  the  crista  of  the  pubes,  is 
Gimbernat’s  Ligament,  which  it  will  be  readily  understood, 
means  only  a part  of  the  crural  arch. 

The  ring  in  the  external  oblique  is  rather  triangular  than 
round  ; its  base  is  formed  by  the  body  of  the  pubes,  and  its 
point  is  at  the  place  where  the  tendon  splits.  The  latter 
is  kept  from  parting  still  farther,  by  a fasciculous  of  tendi- 
nous fibres,  which  runs  across  it.  The  tendinous  sides  of 
this  opening  are  called  its  Columns,  and  from  their  situation, 
internal  and  external,  or  upper  and  lower  columns.  In 
the  female  it  is  oval,  and  scarcely  half  an  inch  long. 

12 


178 


OF  THE  TRUNK. 


A View  of  the  Superficial  Muscles  of  the  Left  Side  and  of 
the  Deep  Muscles  of  the  Right  Side,  on  the  Front  of  the 
Trunk. 

Fig.  40. 


1.  Pecloralis  Major. 

2.  Deltoid. 

3.  Anterior  Edge  of  Latissirnus  Dorsi. 

r 4.  Serrated.  Edge  of  Serralus  Major  Antieus., 

5.  Subclavius  Muscle. 

6.  Pectoralis  Minor. 

7.  Coraco-Braehialis.  . 

8.  Biceps  Flexor  Gubiti. 

9.  Coracoid  Process  of  the  Scapula. 

10.  Serratus  Major  Antieus  after  the  removal  o'"  the  Obliquis  Externus 
Abdominis. 


MUSCLES  OF  THE  ABDOMEN. 


179 


11.  External  Intercostal  Muscle  of  the  Fifth  Intercostal  Space. 

12.  External  Oblique  of  the  Abdomen. 

13.  Its  Tendon.  The  Median  Line  is  the  Linea  Alba.— The  line  to  the 

Right  of  the  number  is  the  Linea  Semilunaris. 

14.  The  portion  of  the  Tendon  of  the  External  Oblique,  known  as  Pou- 

part’s  Ligament. 

15.  External  Abdominal  Ring. 

1 6.  Rectus  Abdominis.  The  White  Spaces  are  the  Linea  Transversae. 

IT.  Pyramiaalis. 

18.  Internal  Oblique  of  the  Abdomen. 

19.  Common  Tendon  of  the  Internal  Oblique  and  Transversalis. 

20.  Crural  Arch. 

21.  Fascia  Lata  Femons. 

22.  Saphenous  Opening. 

The  Cresentic  Edge  of  the  Sartorial  Fascia  is  seen  just  above  fig.  22, 
and  the  Interior  or  Pubic  Point  of  the  Crescent  is  known  as  Iley’s 
Ligament 

There  are  several  small  round  holes  in  the  tendon  of 
this  muscle,  which  afford  passage  to  nerves  and  to  veins. 
When,  by  the  cleanness  of  the  dissection,  the  tendon  has 
its  characteristic  gloss  and  polish,  they  are  very  distinct. 

Use.  This  muscle  compresses  the  viscera  of  the  abdo- 
men, and  brings  the  pelvis  and  thorax  towards  each  other. 
Latterly,  the  attention  of  anatomists  has  been  directed  to  a 
flat  band  of  cellulo-fibrous  matter,  called  the  Ventrier,  or 
Belly  Band,  which  arises  from  the  tendon  of  the  external 
oblique  from  the  linea  alba  to  the  linea  semilunaris,  just 
above  the  internal  abdominal  ring,  and  passes  downwards, 
to  be  inserted  into  the  fascia  femoris  over  the  origin  of  the 
gracilis.  Its  outer  margin  reposes  in  front  of  the  spermatic 
cord,  and  leads  it  outwards  as  the  band  goes  downwards. 

The  external  oblique  is  now  to  be  turned  over  to  the 
other  side,  by  dissecting  up  its  origin  from  the  ribs,  and  its 
insertion  into  the  crista  of  the  ilium.  This  process  will 
enable  the  student  to  gain  a more  satisfactory  view  of  its 
insertion  into  the  spine  and  crista  of  the  pubes. 

2.  The  Obliquus  Internus,  lies  beneath  the  last,  and  its 
fibres  pass  in  a transverse  direction  to  the  fibres  of  the 
other.  It  arises  tendinously,  and  by  the  fascia  lumborum, 
from  the  three  inferior  spinous  processes  of  the  loins,  and 
from  all  those  of  the  sacrum;  tendinous  and  fleshy,  from  the 
whole  length  of  the  crista  of  the  ilium,  and  fleshy  from  the 
upper  half  of  Poupart’s  ligament.  Though  the  fibres  of 
this  muscle,  in  general  decussate  the  fibres  of  the  external 


180 


OF  THE  TRUNK. 


oblique,  all  of  them  do  not,  for  the  lower  are  brought  gra- 
dually to  pursue  the  same  direction  towards  the  symphysis 
of  the  pubes. 

Near  the  Linea  Semilunaris,  the  muscular  fibres  cease, 
and  the  tendon  begins. 

It  is  inserted  into  the  cartilaginous  margin,  formed  by 
the  six  inferior  ribs ; that  is,  by  fibrous,  condensed,  cellular 
membrane,  into  the  cartilages  of  the  seventh,  eighth,  and 
ninth  ribs,  and  by  flesh  into  the  tenth,  eleventh,  and  twelfth. 
It  is  inserted  also,  into  the  side  of  the  ensiform  cartilage,  its 
whole  length;  and  into  the  linea  alba,  from  the  sternum  to 
the  pubes. 

The  tendon  of  this  muscle  divides  into  two  laminrn,  in  a 
manner  which  will  be  better  explained  presently,  after  the 
rectus  and  pyramidalis  muscles  have  been  dissected  and 
turned  down. 

Its  use  is  the  same  as  that  of  the  External  Oblique. 

The  Internal  Oblique  is  now  to  be  dissected  up  from  its 
attachments  to  the  ribs,  vertebrae,  ilium,  and  external  half 
of  Poupart’s  ligament ; by  beginning  near  the  spine  of  the 
ilium,  where  it  is  separated  more  distinctly  from  the  muscle 
below,  by  the  circumflex  ilii  artery,  vein,  and  cellular  sub- 
stance. 

3.  The  Transversalis  Abdominis,  arises  by  the  Fascia 
Lumborum,  from  the  transverse  processes  of  the  last  dorsal, 
and  of  the  four  upper  lumbar  vertebrae,  and  also  by  it  from 
the  posterior  third  of  the  spine  of  the  ilium.  t likewise 
arises  fleshy  from  the  anterior  two-thirds  of  the  spine  of  the 
ilium,  and  from  the  upper  half  of  Poupart’s  ligament ; ten- 
dinous and  fleshy  alternately,  from  the  inferior  margin  of 
the  thorax,  formed  by  the  cartilages  of  the  six  or  seven  in- 
ferior ribs,  at  their  inner  surfaces,  where  they  are  concerned 
in  the  origin  of  the  diaphragm. 

The  fleshy  part  of  the  muscle  occupies  about  one-third 
of  its  extent.  It  is  inserted  into  the  side  of  the  ensiform 
cartilage,  filling  up  the  vacancy  between  it  and  the  carti- 
lages of  the  sixth  and  seventh  ribs,  and  into  the  linea  alba, 
from  the  extremity  of  the  sternum  to  the  pubes. 

Use,  to  compress  the  contents  of  the  abdomen. 


MUSCLES  OF  THE  ABDOMEN. 


181 


Fig.  41. 


A Lateral  View  of  the  Mus- 
cles of  the  Trunk,  espe- 
cially on  the  Abdomen. 

1.  Latissimus  Dorsi. 

2.  Serratus  Major  Anticus. 

3.  Upper  portion  of  the  External 

Oblique. 

4.  Two  of  the  External  Inter- 

costal Muscles. 

5.  Two  of  the  Internal  Inter- 

costal Muscles. 

6.  Transversalis  Abdominis. 

7.  Fascia  Lumborum. 

8.  Posterior  part  of  the  Sheath 

of  the  Rectus  or  Anterior 
Aponeurosis  of  the  Trans- 
versalis Muscle. 

9.  The  Rectus  Abdominis  cut 

off  in  its  Sheath. 

10.  Rectus  Abdominis  of  the 

Right  Side. 

11.  Crural  Arch. 

12.  Gluteus  Magnus — Mediusand 

Tensor  Vagin®  Femoris,  co- 
vered by  the  Fascia  Lata. 


4.  The  Rectus  Abdominis  muscle  is  seen  beneath  the 
tendons  of  the  other  muscles,  on  each  side  of  the  linea 
alba.  A longitudinal  cut,  its  whole  length,  is  to  be  made 
on  its  inner  edge  through  these  tendons,  and  they  turned 
over  towards  the  linea  semilunaris.  Its  origin  will  then  be 
seen  as  a flat  tendon  of  an  inch  or  more  in  breadth,  coming 
from  the  symphysis  pubis  and  the  upper  posterior  part  of 
the  body  of  the  pubes.  The  muscle  increases  gradually  to 
the  breadth  of  three  or  four  inches  in  its  ascent.  The  ten- 
dinous intersections,  confining  it  to  the  tendinous  sheath  in 
front,  are  established  at  the  places  mentioned  as  linse  trans- 
versse,  but  for  the  most  part,  they  do  not  extend  through 
the  muscle. 

Inseited  fleshy,  into  the  base  of  the  cartilago  ensiformis 
and  into  the  cartilages  of  the  fifth,  sixth,  and  seventh 
ribs. 


182 


OF  THE  TRUNK. 


It  draws  the  thorax  towards  the  abdomen. 

5.  The  Pyramidalis,  is  at  the  lower  front  part  of  the 
rectus,  and  is  about  three  inches  long.  It  arises  somewhat 
thick,  tendinous,  and  fleshy,  from  the  upper  part  of  the 
pubes,  from  near  its  spine  to  the  symphysis,  between  the 
rectus  behind  and  the  insertion  of  the  external  oblique  be- 
fore, and  is  fixed  in  a sheath  formed  by  the  separation  of 
the  common  tendon  of  the  transversalis  and  internal  oblique 
muscles.  It  tapers  to  a point  above,  and  is 

Inserted,  into  the  linea  alba  and  internal  edge  of  the  rec- 
tus, two-thirds  of  its  own  length,  by  beginning  about  an 
inch  above  the  pubes. 

It  strengthens  the  lower  part  of  the  abdomen,  but  is  often 
wanting. 

The  Rectus  and  the  Pyramidalis  muscles,  are  now  to  be, 
detached  from  their  origins,  and  turned  aside.  By  doing 
so,  we  become  sensible  of  an  arrangement  of  the  tendons 
of  the  broad  muscles,  always  difficult  to  describe  intelligi- 
bly, and  generally  imperfectly  understood.  It  is  this  ; at 
the  linea  semilunaris,  the  tendon  of  the  internal  oblique  and 
that  of  the  transversalis  unite  intimately,  and  just  beyond 
this  junction  two  laminae  are  formed,  which  enclose  the  rec- 
tus muscle.  The  anterior  lamina,  is  one-half  of  the  tendon 
of  the  internal  oblique,  which,  after  passing  half  an  inch  or 
an  inch,  is  joined  to  the  tendon  of  the  external  oblique,  and 
the  two  thus  go  in  front  of  the  rectus  muscle,  and  cover  it 
from  origin  to  insertion.  The  posterior  lamina,  is  made  by 
the  posterior  half  of  the  tendon  of  the  internal  oblique, 
united  at  the  linea  semilunaris  to  the  tendon  of  the  transver- 
salis; they  in  this  manner  pass  behind  the  rectus  muscle,  from 
the  cartilago  ensiformis,  to  a line  half-way  between  the  umbili- 
cus and  the  pubes.  From  this  line  downwards,  all  the  ten- 
dons go  in  front  of  the  rectus  muscle.  The  obliquus  ex- 
ternus  tendon,  may  however,  be  dissected  from  the  common 
tendon  of  the  others,  without  much  difficulty,  almost  to  the 
linea  alba. 

The  term  insertion,  is  very  inadequate  to  express  the 
manner  in  which  the  tendons  of  these  broad  muscles  all 
terminate  in  the  linea  alba,  from  the  thorax  to  the  pelvis;  but 


MUSCLES  OF  THE  ABDOMEN. 


183 


the  inspection  of  the  part,  will  qualify  the  term  so  as  to 
prevent  mistakes. 

The  Cremaster  muscle,  is  commonly  attributed  ex- 
clusively to  the  internal  oblique,  as  it  is  said  to  be  a de- 
tachment of  fibres  from  it.  The  dissection  is  now  in  a 
state,  to  exhibit  what  is  really  the  fact  in  regard  to  this 
muscle,  viz.,  that  it  is  also  formed,  by  fibres  from  the  lower 
edge  of  the  transversalis  muscle.  The  history  of  its  formation 
is  as  follows:  in  the  descent  of  the  testicle,  the  latter  has  to 
pass  beneath  that  edge  of  the  transversalis,  and  of  the  in- 
ternal oblique,  which  is  extended  from  the  upper  part  of 
Poupart’s  ligament,  to  the  spine  and  crista  of  the  pubes,  but 
as  it  descends,  it  comes  in  contact  with  a fasciculus  of  these 
fibres  and  takes  it  along.  This  fasciculus  constitutes  the 
Cremaster  muscle,  which  in  adult  life  and  in  a strong 
muscular  subject,  is  seen  descending  on  the  outside  of  the 
spermatic  cord,  and  spreading  over  the  anterior  part  of 
the  tunica  vaginalis  in  arches,  with  their  convexities  down- 
wards, then  rising  on  the  inner  side  of  the  cord  and  in- 
serted into  the  spine  of  the  pubes.* 

It  draws  up  the  testicle. 

As  one  becomes  acquainted  with  the  dissection  of  this 
part  by  operating  on  a number  of  subjects,  he  will  be  sen- 
sible that  there  are  differences  in  individuals,  which  render 
the  established  descriptions,  occasionally  unsuitable.  One 
of  the  most  usual,  is  the  deficiency  of  the  transversalis  muscle 
in  that  part,  the  origin  of  which  is  usually  attributed  to  the 
upper  half  of  Poupart’s  ligament.  In  this  case  the  internal 
oblique  has  increased  thickness,  and  of  course,  the  cremas- 
ter will  be  exclusively  derived  from  it.  In  other  instances 
the  two  muscles  are  so  much  blended,  that  they  cannot  be 
satisfactorily  separated  from  each  other. 

The  Transversalis,  and  the  Internal  Oblique,  perform  so 
important  a part  in  the  doctrines  of  Hernia,  that  one  desirous 
of  understanding  them  well,  should  at  this  time,  again  pay 

* Mr.  J.  Cloquet,  of  Paris,  has  given  this  explanation  of  the  for- 
mation of  the  cremaster,  and  it  sometimes  is  manifest  in  the  adult;  it 
is,  however,  not  in  accord  with  Mr.  Hunter’s  account  of  it,  neither 
does  it  correspond  with  what  I have  witnessed  in  the  male  buffalo, 
in  a specimen  given  to  me  by  Dr.  Harlan.  Mr.  Hunter  has  seen  the 
muscle  running  up  the  testis,  while  the  latter  was  still  in  the  loins. 


184 


OF  THE  TRUNK. 


attention  to  the  mode  of  their  insertion  into  the  pubes. 
It  will  thus  be  seen  that  they  form  below,  a common  ten- 
don, which  is  inserted  for  an  inch,  into  the  crista  of  the 
pubes  behind  Gimbernat’s  ligament,  into  its  spine,  and  into 
that  part  of  its  body  which  is  behind  the  external  ab- 
dominal ring  ; and  that  just  within  and  above  their  inser- 
tion, the  same  common  tendon  splits  into  two  laminae,  one 
going  before,  the  other  behind  the  pyramidalis  muscle, 
thus  forming  a sheath  for  it  as  just  stated. 

In  examining  the  origins  of  the  Recti  muscles  from  be- 
hind, the  peritoneum  being  stripped  off,  it  will  be  seen  that 
a protrusion  of  intestine  between  them,  is  prevented  by  the 
internal  edge  of  the  one  tendon  overlapping  the  internal  edge 
of  the  other;  and  by  a triangular  ligament  called,  by  Mr. 
Breschet  its  discoverer,  the  Superior  Pubic  Ligament. 


SECTION  II. 

Of  the  parts  concerned  in  Inguinal  Hernia. 

It  is  better  for  the  student  to  postpone  the  subject  of  Her- 
nia, until  he  has  become  acquainted  with  the  abdominal 
muscles  and  the  contents  of  the  abdomen.  When  he  has 
paid  due  attention  to  what  is  remarked  concerning  them, 
the  rest  of  the  investigation  will  be  comparatively  easy. 

Make  an  incision  through  the  skin  and  fat,  from  the  Um- 
bilicus to  the  dorsum  of  the  Penis,  and  extend  it  for  three 
or  four  inches  along  the  inner  margin  of  the  thigh;  com- 
mence another  at  right  angles  with  the  beginning  of  this, 
and  continue  it  from  the  umbilicus,  in  a straight  line  to- 
wards either  flank;  make  a third  incision  parallel  with  the 
first,  beginning  an  inch  behind  the  anterior  superior  spinous 
process  of  the  ilium,  and  terminating  in  the  second  incision. 
The  flap  of  skin  thus  marked  out,  must  be  turned  down 
over  the  thigh  by  a careful  dissection,  which  will  bring  into 
view  the  fascia  superficialis  abdominis. 


INGUINAL  HERNIA. 


185 


The  Fascia  Superficialis,  consists  of  condensed  cellular 
substance,  with  but  very  little  fibrous  matter  in  it,  and  may 
be  considered  as  taking  its  origin  on  the  front  of  the  thigh, 
and  extending  in  front  of  the  abdominal  muscles,  as  high 
up  as  the  thorax ; indeed,  if  we  are  disposed  to  trace  it  to 
its  whole  extent,  there  is  no  difficulty  in  following  it  over 
the  front  of  the  thorax,  also  to  the  neck,  and  even  to  the 
face.  In  ordinary  cases,  its  desmoid  or  aponeurotic  charac- 
ter is  very  equivocal,  but  where  the  parts  about  the  groin 
have  been  pressed  upon  and  thickened  by  the  irritation  of 
hernial  protrusion,  it  is  better  developed.  On  the  thigh  it  is 
blended  with  fat,  and  encloses  between  its  laminae,  the  lym- 
phatic glands  of  the  groin  and  the  external  pudic  vessels, 
given  off  from  the  femoral  artery  immediately  below  Pou- 
part’s  ligament.  On  the  tendon  of  the  external  oblique  it 
is  more  condensed  ; branches  of  the  femoral  artery  are  also 
seen  in  it  there;  one  longer  and  larger  than  the  others,  the 
Arteria  ad  Cutem  Abdominis  of  Haller,  winds  over  Pou- 
part’s  ligament  and  runs  upwards  somewhat  in  the  line  of 
the  epigastric  artery,  being  distributed  to  the  skin  of  the 
abdomen;  the  division  of  it  will  produce  sufficient  hemor- 
rhage to  require  attention.  On  the  symphysis  pubis  and 
about  the  external  ring,  the  laminm  of  the  fascia  superficia- 
lis are  multiplied,  and  it  has  more  of  the  character  of  com- 
mon adipose  matter,  as  in  most  cases  the  adeps  there,  is 
abundant,  and  forms  in  both  sexes  the  protuberance  called 
Mons  Veneris  or  Penil.  From  the  pubes,  it  may  be  traced 
as  a condensed  cellular  membrane,  along  the  penis  to  its 
extremity,  and  according  to  Mr.  Colles  of  Dublin,  when 
matter  is  formed  beneath  it,  is  apt  to  create  fistulous  sores 
in  this  organ.  This  fascia  is  more  loosely  connected  to  the 
parts  beneath  it,  along  the  anterior  margin  of  Poupart’s 
ligament  than  elsewhere,  which  disposes  the  femoral  her- 
nia to  observe  that  course  in  its  increase.  A thin  lamina 
of  this  membrane,  may  also  be  traced  for  some  distance 
along  the  spermatic  cord,  and  identified  with  the  tunica 
vaginalis  communis. 


186 


OF  THE  TRUNK. 


A View  of  the  External  parts  concerned  in  Inguinal  and  Femoral 
Hernia. 


Fig.  42. 


1.1.  The  common  Integuments  and  Adipose  Tissue  of  the  Abdomen 
turned  back. 

2.  The  Penis  with  its  Suspensory  Ligament,  deprived  of  the  Integu- 

ments. 

3.  Integuments  of  the  Scrotum  drawn  down. 

4.  Fascia  Superficialis  of  the  Abdomen. 

5.  The  same  on  the  Thigh. 

6.  The  Left  Spermatic  Cord  covered  by  the  Fascia  Superficialis. 

7.  The  Inguinal  Glands  which  are  placed  on  the  Fascia  Superfi- 

cialis. 

S.  Branch  of  the  External  Pudic  Artery. 

9.  Fascia  Superficialis  turned  off  the  Thigh. 

10.  Tendon  of  the  External  Oblique. 

11.  Linea  Alba. 

12.  External  Oblique  Muscle. 

13.  External  Abdominal  Ring. 

14.  Its  Superior  Column. 

15.  Its  Inferior  column. 


INGUINAL  HERNIA. 


187 


] fi.  Testicle  covered  by  the  Cremaster  Muscle. 

17.  Anterior  Superior  Spinous  Process. 

18.  Close  Attachment  of  the  Fascia  Superficialis  on  the  outside  of  the 

Thigh. 

19.  Cribriform  Openings  in  the  Fascia  Lata  Femoris. 

20.  Saphenous  Opening. 

21.  Branch  of  the  Saphena  Vein. 

22.  Saphena  Vein. 

23.  External  Femoral  Ring. 

24.  Testicle. 

The  Fascia  Superficialis,  under  the  name  of  Tunica 
Abdominalis,  is  well  developed  in  animals  with  a large  and 
projecting  belly,  particularly  in  the  large  ruminantia  and 
the  solipedia.  It  has  a yellowish  tinge,  is  very  elastic 
and  strong,  and  well  calculated  to  support  the  viscera  in 
them. 

In  dissecting  at  the  Abdominal  Ring,  do  not  work  too 
closely  between  the  spermatic  cord  and  the  margin  of  the 
ring;  by  which  precaution  we  avoid  cutting  the  process  of 
the  fascia  superficialis  that  unites  the  two.  This  process 
arises  from  the  margin  of  the  ring  all  around  ; it  passes 
immediately  to  the  spermatic  cord,  and  is  lost  insensi- 
bly on  the  exterior  surface  of  the  cremaster  muscle.  A 
quantity  of  loose  cellular  substance,  intermixed  with  fat, 
is  placed  between  the  constituent  parts  of  the  cord  and 
the  cremaster  muscle.  This  cellular  substance,  the  cremas- 
ter muscle,  and  the  fascia  superficialis,  form  in  scrotal 
ruptures,  a thick  lamina  over  the  hernial  sac,  called  Tunica 
Vaginalis  Communis. 

Next  make  an  incision  through  the  fascia  superficialis 
and  the  tendon  of  the  external  oblique,  commencing  at 
the  Linea  Semilunaris,  a quarter  of  an  inch  above  the  upper 
margin  of  the  external  ring,  and  ending  a quarter  of  an 
inch  above  the  anterior  superior  spinous  process  of  the  ilium. 
This  incision  should  be  regularly  curved,  its  convexity 
being  downwards,  and  almost  touching  the  middle  of  Pou- 
part’s  ligament.  The  tendon  of  the  external  oblique,  bor- 
dering on  the  incision,  should  be  then  turned  upwards  and 
downwards,  by  which  a good  view  is  given  of  the  inferior 
part  of  the  internal  oblique  muscle,  where  it  arises  from  the 
iliac  or  upper  half  of  Poupart’s  ligament,  and  is  inserted 
into  the  body  and  crista  of  the  pubes,  just  behind  the  ex- 


188 


OF  THE  TRUNK. 


ternal  abdominal  ring.  The  origin  of  the  cremaster  mus- 
cle is  well  seen,  and  the  constitutent  parts  of  the  cord,  as 
they  are  about  to  enter  into  the  external  ring. 

Separate  the  inferior  margin  of  the  internal  oblique  from 
Poupart’s  ligament,  and  turn  it  upwards,  beginning  near  the 
anterior  superior  spinous  process  of  the  ilium,  where  the  dis- 
tinction between  the  internal  oblique  and  the  transversalis  is 
better  marked.  The  lower  part  of  the  transversalis  is  thus 
exhibited,  placed  behind  the  internal  oblique,  and  having  the 
same  origin  from  Poupart’s  ligament  and  the  same  insertion 
into  the  pubes.  The  raising  of  the  internal  oblique,  brings 
into  view  more  of  the  spermatic  cord,  near  the  external 
ring. 

The  Transversalis  Muscle  is  then  to  be  detached  from 
Poupart’s  ligament,  and  raised  up.  This  gives  a complete 
view  of  the  spermatic  cord,  consisting  here  of  its  vessels, 
nerves,  and  excretory  duct,  united  by  cellular  membrane. 
The  upper  part  of  the  visible  portion  of  the  cord,  is  about 
half  way  between  the  anterior  superior  spinous  process  of 
the  ilium  and  the  symphysis  of  the  pubes,  and  penetrates 
the  fascia  transversalis.  The  fascia  transversalis  is  placed 
immediately  behind  the  transversalis  muscle,  between  it  and 
the  peritoneum.  An  opening  of  the  fascia  transversalis. 
which  permits  the  cord  to  pass,  is  called  tire  Internal  Ab- 
dominal Ring,  in  order  to  distinguish  it  from  the  opening 
in  the  tendon  of  the  external  oblique,  called  the  External 
Ring.  The  internal  ring  is  rather  nearer  to  the  symphysis 
pubis,  than  to  the  spinous  process  of  the  ilium.  It  will 
now  be  understood,  that  the  space  between  the  internal  ring 
and  the  external  ring,  is  about  eighteen  lines  in  the  adult, 
and  that  it  is  very  properly  called  the  Abdominal,  Inguinal, 
or  Spermatic  Canal,  as  giving  passage  to  the  spermatic 
cord.  The  anterior  side  of  the  canal,  is  formed  by  the 
tendon  of  the  external  oblique ; the  inferior  part  in  the  erect 
posture  is  formed  by  Gimbernat’s  ligament ; the  posterior 
parietes  are  formed  by  the  fascia  transversalis,  and  above,  the 
canal  is  overhung  by  the  internal  oblique  and  transversalis 
muscles.  It  should  be  observed,  that  the  spermatic  cord, 
after  penetrating  the  fascia  transversalis,  does  not  cross 
directly  the  inferior  edge  of  the  internal  oblique  and  trans- 


INGUINAL  HERNIA. 


189 


versalis  at  right  angles,  but  crosses  them  very  obliquely, 
its  inclination  being  towards  the  pubes,  so  that  the  spermatic 
cord  can  only  be  considered  as  disengaged  from  the  infe- 
rior edge  of  these  muscles,  about  the  middle  of  the  abdo- 
minal canal. 

The  opening  in  the  Fascia  Transversalis,  or  the  Internal 
Ring,  is  not  abrupt  and  well  defined ; but  the  fascia,  where 
it  transmits  the  spermatic  cord,  is  reflected  by  a thin  pro- 
cess, or  sheath,  to  the  cord,  and  insensibly  terminates  in 
its  cellular  substance.  At  the  posterior  or  ventral  face  of 
the  External  Ring,  the  fascia  transversalis  is  not  in  contact 
with  the  cord,  but  that  part  of  the  tendon  of  the  internal 
oblique  and  transversalis  which  is  inserted  into  the  crista 
and  body  of  the  pubes,  and  forms  a sheath  for  the  pyrami- 
dalis  muscle,  is  placed  between  them,  and  secures  this 
opening. 

The  incisions  which  wrere  originally  made  only  through 
the  skin  of  the  abdomen,  are  now  to  be  carried  through  the 
parietes  of  the  same  into  its  cavity,  and  the  flap  thus  con- 
stituted, to  be  turned  down  in  order  to  get  a view  of  its 
posterior  or  ventral  face.  This  surface  covered  by  perito- 
neum, is  divided  in  the  iliac  region  near  the  middle  of  Pou- 
part’s  ligament,  into  two  superficial  fossse,  by  a narrow,  falci- 
form process  of  the  peritoneum.  The  process  arises  from 
the  side  of  the  bladder,  and  extends  upwards  and  inwards 
towards  the  umbilicus,  stopping  about  two  inches  short  of 
the  umbilicus.  It  is  broader  below  than  it  is  above,  and  its 
loose  edge  is  turned  towards  the  abdomen.  By  stripping 
down  the  peritoneum,  we  shall  see  that  this  falciform  process 
is  simply  a duplicature  of  it,  occasioned  by  the  fibrous 
cord,  the  umbilical  ligament  of  the  bladder,  which  once 
was  the  umbilical  artery  of  the  foetus.  This  cord  passes 
near  the  pubic  margin  of  the  internal  abdominal  ring.  Re- 
placing the  peritoneum,  we  become  convinced  that  the  bot- 
tom of  the  superficial  fossa  on  the  outer  or  iliac  side  of  the 
falciform  process,  corresponds  with  the  internal  abdominal 
ring,  and  frequently  a little  pouch  of  peritoneum  enters  the 
latter.  The  fossa  on  the  inner  or  pubic  side  of  the  falciform 
process,  is  just  behind  the  external  ring,  but  separated  from 
it  by  the  fascia  transversalis,  and  by  the  tendon  of  the  lower 


190 


OF  THE  TRUNK. 


parts  of  the  internal  oblique,  and  the  transversalis  muscles 
where  they  are  inserted  into  the  pubes,  and  form  the  sheath 
of  the  pyramidalis.  The  two  fossae  indicate  the  points 
where  inguinal  herniae  commence,  the  proper  inguinal  pro- 
trusion beginning  generally  in  the  external  fossa,  and  the 
ventro-inguinal  in  the  internal  fossa.  Such,  at  least,  is  the 
opinion  of  some  writers,  though  it  is  not  held  by  others,  as 
they  believe,  (of  which  I have  had  evidence,)  that  all  cases 
of  hernia  at  the  groin,  both  inguinal  and  lentro-inguinal, 
begin  in  the  external  fossa.  The  Herman  anatomists  are 
decidedly  of  this  opinion.  We  should  here  notice,  die 
looseness  of  the  attachment  of  the  peritoneum  by  cellular 
substance  to  the  parietes  of  the  abdomen,  and  consequently 
the  little  resistance  which  it,  unsupported,  can  afford  against 
intestinal  protrusion. 

The  view  of  the  Fascia  Transversalis  from  behind,  is 
extremely  satisfactory.  For  a proper  knowledge  of  this 
membrane,  the  profession  is  indebted  to  the  labours  of  Sir 
Astley  Cooper,  and  much  of  the  zeal  with  which  the  ana- 
tomy of  hernia  has  been  investigated  in  latter  years,  is  at- 
tributable to  him.  The  fascia  transversalis  is  most  gene- 
rally, a thin  tendinous  membrane;  occasionally  it  more  closely 
resembles,  condensed  cellular  membrane.  It  arises  from  the 
internal  or  abdominal  edge  of  Poupart’s  ligament,  and  from 
the  crista  of  the  pubes  just  behind  the  insertion  of  the  tendon 
of  the  internal  oblique  and  transversalis  muscles,  and  is  ex- 
tended upwards  on  the  posterior  face  of  the  transversalis 
muscle  to  the  thorax.  At  its  origin,  it  is  attached  to  the  in- 
ferior edge  of  the  transversalis  and  internal  oblique,  par- 
ticularly that  part  of  their  edge,  between  the  internal  ring 
and  the  pubes.  It  is  also  attached  to  the  exterior  margin 
of  the  rectus  abdominis,  where  the  muscle  is  destitute  of  its 
sheath  behind,  and  it  is  then  continued  on  to  the  linea  alba. 
The  internal  abdominal  ring,  or  opening  in  this  fascia,  marks 
it  out  in  some  measure  as  consisting  of  two  portions,  that 
on  the  iliac  side  of  the  ring  is  not  so  thick  as  the  other,  or 
the  one  on  its  pubic  side,  and  both  portions  are  much  more 
tendinous  near  the  crural  arch,  than  they  are  higher  up. 
Were  it  not  for  the  important  influence  of  the  fascia  super- 
ficialis  and  the  fascia  transversalis,  upon  hernia,  and  ihe 
consequent  necessity  of  a minute  knowledge  of  them,  the 


INGUINAL  HERNIA. 


191 


description  might  be  much  curtailed,  in  considering  them  in 
their  proper  light,  to  wit,  as  the  sheaths  of  muscles ; for  it 
is  now  sufficiently  apparent  that  the  first  is  contiguous  to  the 
external  oblique,  and  the  second  to  the  transversalis  muscle. 

Removing  the  peritoneum  from  the  iliacus  internus  mus- 
cle, we  see  the  spermatic  vessels,  descending  from  the  loins 
to  the  internal  ring,  where  they  are  joined  by  the  vas  defe- 
rens coming  from  the  pelvis.  As  they  engage  under  the 
edge  of  the  internal  oblique  muscle,  after  penetrating  the 
ring,  the  cremaster  muscle  is  detached  to  spread  itself  over 
them.  The  spermatic  cord,  thus  constructed,  passes 
through  the  abdominal  canal  in  the  manner  mentioned,  ob- 
liquely downwards  and  inwards ; emerging  from  the  external 
ring,  it  descends  vertically,  lying  rather  upon  the  outer 
column  of  the  ring,  than  upon  its  base. 

On  the  posterior  face  of  the  fascia  transversalis,  between 
it  and  the  peritoneum,  is  the  Epigastric  Artery.  The  epi- 
gastric, arises  from  the  external  iliac  as  the  latter  is  about  to 
go  under  Poupart’s  ligament ; it  ascends  inwardly  along 
the  internal  margin  of  the  internal  abdominal  ring,  to  the 
exterior  margin  of  the  rectus  abdominis  muscle,  which  it 
reaches  after  a course  of  two  and  a half,  or  three  inches. 
The  spermatic  cord,  in  getting  from  the  abdomen  to  the 
abdominal  canal,  therefore  winds  in  part,  around  the  epi- 
; gastric  artery,  in  the  first  of  its  course  being  at  the  iliac 
' edge  of  the  artery,  and  then  in  front  of  it.  Two  epigastric 
veins  attend  the  artery,  one  on  each  side,  which  end  by  a 
| common  trunk  in  the  external  iliac  vein. 

From  what  has  been  said,  it  will  now  be  more  fully  un- 
derstood that  this  structure  admits  of  two  places  of  pro- 
trusion. In  the  first,  the  intestine  protrudes  the  peritoneum 
through  the  internal  ring  and  along  the  abdominal  canal,  into 
the  groin,  the  constituent  parts  of  the  cord  are  behind  the 
sac  and  separated  by  it,  from  the -cremaster  muscle,  which, 
in  this  case,  form’s  one  of  the  envelopes  of  the  sac.  In  the 
| second,  from  weakness  of  the  fascia  transversalis  and  the 
pubic  insertion  of  the  internal  oblique  and  transversalis 
muscles,  a protrusion  immediately  from  behind  the  external 
ring  may  occur,  in  which  the  whole  cord,  including  the 
cremaster,  is  at  the  outer  margin  of  the  sac.  In  the  first 


192 


OF  THE  TRUNK. 


species,  or  the  Inguinal  Hernia,  the  epigastric  artery  is  at 
the  pubic  side  of  the  neck  of  the  sac  ; but  in  the  second,  or 
the  Ventro-Inguinal,  it  is  at  the  iliac  side. 

The  anatomical  arrangement  of  the  parts  concerned  in 
inguinal  hernia  in  the  female,  is  the  same  as  in  the  male, 
except  that  the  round  ligament  of  the  uterus  supplies  the 
place  of  the  spermatic  cord,  and  there  is  no  cremaster  mus- 
cle. 


SECTION  III. 

Of  the  parts  concerned  in  Femoral  Hernia. 

The  study  of  Femoral  Hernia,  should  be  commenced, 
with  precise  ideas  of  the  concave  edge  of  the  os  innomi- 
natum,  which  terminates  externally,  by  the  anterior  superior 
spinous  process  of  the  ilium,  and  internally  by  the  symphy- 
sis pubis ; — also  of  the  muscles  of  the  lower  extremity, 
which  are  connected  with  this  edge ; — and  of  tire  insertion 
of  the  tendon  of  the  external  oblique. 

A muscular  subject  without  much  fat  answers  sufficiently 
well  for  this  dissection ; the  male  black,  is  therefore,  most 
frequently  resorted  to  in  our  school.  If  the  subject  have 
suffered  somewhat  from  a previous  infiltration  or  dropsy  of 
the  cellular  membrane,  the  facility  of  separating  the  diffe- 
rent layers  of  fascia  from  each  other,  is  much  increased. 
Make  an  incision  through  the  skin,  from  the  umbilicus  to  the 
root  of  the  penis,  and  extend  the  lower  end  of  the  incision 
around  the  penis  along  the  internal  margin  of  the  thigh  for 
six  inches.  Commence  a second  incision  at  tire  umbilicus, 
and  carry  it  out  to  the  flank  of  the  side  on  which  you  ope- 
rate. Begin  a third  incision  through  the  skin  at  the  termi- 
nation of  the  first,  and  carry  it  to  tire  outer  side  of  the  thigh. 
A flap,  consisting  simply  of  skin,  being  thus  described,  is 
to  be  carefully  raised  and  turned  out  of  the  way.  In  raising 
this  flap  of  skin,  guard  against  cutting  up  with  it,  the  fascia 


FEMORAL  HERNIA. 


193 


1.1.  Integuments  and  Adipose  Tissue. 

2.  Integuments  of  the  Scrotum. 

3 3.  Fascia  Superfieialis  Abdominis  and  Fascia  Lata  Femoris  turned 

off. 

4.  External  Oblique  Muscle. 

5.  Its  Tendon. 

(1.  Linea  Alba. 

7.  Lower  part  of  the  External  Oblique  Tendon,  divided  and  turned 
back. 

?.  Right  Testicle  in  the  Tunica  Vaginalis  Testis. 

9.  Internal  Oblique  and  Transversalis  Muscles. 

10.  Epigastric  Artery  and  vein,  as  placed  between  the  Fascia  Trans- 
versalis and  the  Peritoneum. 

13 


superfieialis  abdominis,  which  lies  immediately  beneath, 
and  which  is  next  to  be  dissected  up. 


A View  of  the  deep-seated  parts  concerned  in  Inguinal  and 
Femoral  Hernia. 


Fig.  43. 


194 


OF  THE  TRUNK. 


11.  Points  to  the  Surface  of  the  Peritoneum,  through  the  Internal  Ab- 

dominal Ring. 

12.  Cord  covered  by  the  Cremaster  Muscle  laying  in  the  Abdominal 

Canal. 

13.  External  Abdominal  Ring,  laid  open. 

14.15.  Fascia  Propria  of  the  Vessels  laid  open  so  as  to  expose  them. 

16.  Pectineus  Muscle. 

17.  The  Vessels  in  their  Sheath. 

18.  Penis  and  Ligamentum  Suspensorium. 

19.  Testicle  and  Cord,  in  its  entire  length. 

The  Fascia  Femoris,  is  beneath  the  fascia  superficialis 
abdominis ; its  general  character  and  arrangement  are  in- 
troduced into  the  account  of  the  lower  extremity,  but  there 
are  other  and  minute  circumstances  in  its  disposition  at  the 
groin,  indispensable  to  a knowledge  of  femoral  hernia. 
When  the  fascia  superficialis  is  cleared  away,  the  fascia 
femoris  is  seen  to  arise  at  the  groin  along  the  anterior  edge 
of  Poupart’s  ligament,  from  the  anterior  superior  spinous 
process  of  the  ilium,  to  within  a short  distance  of  the  spine 
of  the  pubes.  This  portion  of  it  is  thin,  and  through  it 
the  sartorius  muscle  may  be  seen ; it  is  therefore  called  the 
Sartorial  Fascia.  The  fascia  femoris,  arises  also  from  the 
spine  and  crest  of  the  pubes,  and  along  its  ilio-pectineal 
ridge,  which  is  a continuation  of  the  same ; this  latter  por- 
tion covers  die  pectineus  muscle,  and  is  called  the  Pectineal 
Fascia.  The  pectineal  fascia  is  behind  the  femoral  artery 
and  vein,  and  the  sartorial  fascia  is  before  them. 

The  Saphena  Vein,  placed  between  the  fascia  femoris 
and  the  fascia  superficialis,  runs  up  along  the  inner  side  of 
the  thigh,  and  joins  the  femoral  vein  an  inch  and  a half  be- 
low Poupart’s  ligament.  Raise  the  saphena  where  it  joins 
the  femoral  vein,  and  beneath  this  junction,  a rounded  semi- 
circular edge  of  the  fascia  femoris  is  seen,  where  the  sarto- 
rial fascia  becomes  continuous  with  the  pectineal.  Apply 
the  end  of  a finger  to  this  edge  and  draw  it  downwards. 
Immediately  on  its  being  made  tense,  the  sartorial  fascia 
will  show  itself  to  terminate  by  a thin  edge  in  front  of  the 
femoral  vein.  This  edge  is  concave  or  crescentic,  and  ex- 
tends from  the  junction  of  the  sartorial  and  pectineal  fascia, 
to  the  crista  of  the  pubes ; it  is  frequently  reticulated.  At 
the  upper  end  of  this  crescent,  the  sartorial  fascia  termi- 
nates in  a point  or  angle,  which  is  directed  deeply  towards 


FEMORAL  HERNIA. 


195 


the  upper  branch  of  the  pubes.  The  upper  margin  of  this 
angle  is  closely  connected  with  the  edge  of  Gimbernat’s  lig- 
ament, and  the  point  is  inserted  into  the  crista  of  the  pubes 
in  the  same  line  with  Gimbernat’s  ligament,  but  exterior  to 
it,  just  at  the  internal  margin  of  the  femoral  vein.  This 
angular  production  or  elongation  of  the  sartorial  fascia  is 
called  Hey’s  or  the  Femoral  Ligament.  The  free  edge  of 
it  is  turned  towards  the  femoral  blood-vessels,  by  a sort  of 
half  twist. 

The  preceding  arrangement  of  the  fascia  femoris  for  the 
transmission  of  the  saphena  vein  and  the  superficial  lym- 
phatics, gives  the  appearance  of  an  oval  aperture,  called  the 
Saphenous  opening. 

By  introducing  a finger  under  Hey’s  ligament  into  the 
abdomen,  we  find,  that  the  crural  arch  or  Poupart’s  lig- 
ament, and  the  sartorial  fascia,  exercise  a mutual  tension  on 
each  other,  like  the  falx  major  and  the  tentorium  ; by  abduct- 
ing the  limb  very  much,  and  turning  the  toe  outwards, 
the  greatest  rigidity  is  given  to  both,  but  by  making  the 
limb  cross  the  other,  and  turning  the  toe  inwards,  both  are 
relaxed. 

A posterior  view  must  now  be  taken,  by  opening  the  ab- 
domen. The  peritoneum  must  be  separated  from  the  ab- 
dominal muscles,  and  from  the  iliacus  internus  and  psoas 
magnus,  which  brings  into  view  the  fascia  iliaca. 

The  Fascia  Iliaca,  is  a tendinous  membrane  which  lies 
on  the  iliacus  internus  and  psoas  magnus  muscles,  and  is 
continued  into  the  tendon  of  the  psoas  parvus.  Externally,  it 
is  connected  to  the  margin  of  the  crista  of  the  ilium ; at  the 
internal  edge  of  the  psoas  magnus,  it  is  connected  with  the 
brim  of  the  pelvis,  and  sinks  into  the  cavity  of  the  pelvis, 
being  continuous  with  the  Aponeurosis  Pelvica  ; and  below, 
it  is  inserted  into  the  edge  of  the  crural  arch,  from  the  an- 
terior superior  spinous  process,  of  the  ilium,  almost  to  the 
body  of  the  pubes.  The  external  iliac  vessels  are  upon  this 
fascia,  between  it  and  the  peritoneum  ; by  raising  them  with 
a knife-handle,  it  will  be  seen  that  the  fascia  iliaca  goes  over 
that  part  of  the  pubes,  which  gives  origin  to  the  psctineus 
muscle,  and  that  it  is  continuous  with  the  pectineal  fascia. 
If  the  student  should  have  a preparation  in  which  every 


196 


OF  THE  TRUNK. 


thing  is  removed  from  the  os  innominatum  except  the  in- 
sertion of  the  tendon  of  the  external  oblique,  it  will  be 
of  essential  service  to  him  here : for  by  it  will  be  seen  the 
arched  form  of  the  edge  of  the  tendon  next  to  the  bone, 
from  whence  the  name  of  Crural  Arch ; the  vacancy  which 
exists  between  the  bone  and  the  arch ; and  the  insertion  of 
Gimbernat’s  ligament  from  the  spine  of  the  pubes,  an  inch 
or  more  along  its  crista.  He  will  then  understand  how  this 
space  is  only  partly  filled  by  the  iliacus  internus  and 
psoas  magnus,  and  that  if  the  fascia  iliaca  had  not  an  at- 
tachment to  the  crural  arch,  so  as  to  keep  it  down  towards 
these  muscles,  hernial  protrusions  would  be  constantly  oc- 
curring. 

The  Iliac  vessels  pass  beneath  the  crural  arch  on  the  in- 
ner margin  of  the  psoas  magnus  muscle,  the  vein  being 
nearest  the  pubes,  and  the  artery  at  the  outer  side  of  the 
vein.  Close  inspection  will  satisfy  us  that  the  fascia  iliaca 
is  inserted  into  the  crural  arch  as  far  as  the  vein,  and  may 
indeed,  be  traced  to  the  crista  of  the  pubes,  and  that  it  is 
so  connected  with  the  vessels,  that  no  opening  for  hernia 
exists  between  them,  or  indeed,  in  all  the  space  from  the 
internal  margin  of  the  vein,  to  the  anterior  superior  spinous 
process  of  the  ilium.  But  at  the  inner  side  of  the  vein  be- 
tween it  and  Gimbernat’s  ligament,  an  opening  appears 
called  the  Crural  or  Femoral  Ring,  and  is  the  place  where 
femoral  hernia  commences.  This  opening  is  generally  oc- 
cupied by  a lymphatic  gland,  and  a lamina  of  condensed 
but  loosely  attached  cellular  substance,  called  sometimes 
the  Cribriform  Fascia,  continuous  with  the  Aponeurosis 
Pelvica. 

Make  a cross  cut  of  an  inch  in  length,  through  the  fascia 
iliaca;  then  by  introducing  the  finger,  or  a knife-handle 
through  this  cut,  downwards,  our  conceptions  of  the  at- 
tachment of  the  fascia  iliaca  with  the  crural  arch,  and 
its  continuity  with  the  fascia  pectinea,  will  be  much  im- 
proved. 

The  femoral  vessels  are  enveloped  by  a sheath.  To  see 
this  distinctly,  separate  the  fascia  transversalis  from  the 
transversalis  muscle;  cut  vertically  through  the  falciform 


FEMORAL  HERNIA. 


197 


process  of  the  fascia  lata  femoris,  over  the  artery,  and  con- 
tinue the  cut  also  through  Poupart’s  ligament,  taking  care 
to  injure  as  little  as  possible  the  fascia  transversalis.  To 
render  this  part  of  the  examination  convenient,  only  a 
narrow  flap  of  the  abdominal  muscles  should  be  left  at 
the  groin.  By  turning  towards  the  symphysis  pubis  the 
falciform  process,  with  that  part  of  Poupart’s  ligament  to 
which  it  adheres,  we  shall  see  that  the  fascia  transversalis 
is  not  only  attached  to  the  edge  of  the  crural  arch,  but  that 
it  continues  to  the  thigh  in  front  of  the  femoral  vessels. 
The  fascia  iliaca,  besides  its  connexion  with  the  pectineal 
fascia,  gives  a layer  to  the  posterior  face  of  the  femoral  ves- 
sels. The  sheath  of  the  femoral  vessels  is  by  this  method  of 
examination,  proved  to  be  formed  from  the  fascia  transver- 
salis in  front,  and  the  fascia  iliaca  behind.  Mr.  Colies  has 
adopted  a very  satisfactory  mode  of  describing  the  forma- 
tion of  the  crural  sheath,  which  I think  more  expressive 
than  such  as  are  most  in  use.  The  fascia  transversalis 
and  iliaca,  he  considers  as  a continuous  membrane,  which 
may  be  compared  to  a funnel,  from  the  manner  in  which 
it  lines  the  lower  part  of  the  abdomen.  The  inner  half  of 
the  funnel  is  deficient.  From  its  lower  part,  proceeds  the 
membranous  pipe  which  surrounds  the  femoral  vessels,  and 
constitutes  their  sheath.  This  sheath,  is  very  separable 
from  the  sartorial  fascia  in  front  and  the  pectineal  fascia 
behind,  and  may  be  easily  traced,  to  the  entrance  of  the 
saphena  vein  into  the  femoral.  On  the  thigh,  just  below 
Poupart’s  ligament,  it  has  a number  of  foramina  in  it  oc- 
casioned by  the  passage  of  the  lymphatic  and  other  ves- 
sels from  the  surface  of  the  thigh. 

The  texture  of  this  sheath  is  evidently  filamentous  and 
fibrous,  and  there  are  many  of  these  fibres  passing  from  it 
to  the  sartorial  fascia,  and  its  lunated  edge. 

At  the  place  where  the  fascia  iliaca  is  united  to  the  cru- 
ral arch,  a white  line  appears,  formed  by  their  union ; in 
this  is  fixed  the  Arteria  Circumflexa  Ilii,  coming  from  the 
external  iliac.  The  epigastric  artery  is  about  half  an 
inch  distant  from  the  Femoral  or  Crural  Ring,  at  its 
outer  side.  Occasionally,  the  Obturator  Artery  comes 
from  the  Epigastric,  and  winds  around  the  internal  mar- 


198 


OF  THE  TRUNK. 


gin  of  this  ring.  As  the  iliac  vessels  enter  the  sheath  be- 
neath Poupart’s  ligament,  a close  fibrous  connexion  is 
formed  from  them  to  the  sheath  both  anteriorly  and  poste- 
riori}', which  sends  a partition  between  the  artery  and 
the  vain,  and  a partition  also  on  the  inner  side  of  the  vein. 
By  such  arrangement  hernial  protrusions  are  prevented  at 
this  spot;  the  only  opening  for  them,  being  at  the  inner 
side  of  the  vein,  between  it  and  Gimbernat’s  ligament  or 
at  the  Crural  ring,  as  stated. 

When  an  intestine  descends,  it  passes  into  the  femoral 
sheath,  on  the  inner  side  of  the  Iliac  vein,  it  follows  the 
course  of  this  vein  down  the  sheath,  till  it  comes  to  an 
aperture  made  by  one  of  the  lymphatic  vessels,  or  veins; 
it  then  protrudes  through  this  aperture,  and  gets  under  the 
fascia  superficialis.  The  route  thus  indicated,  constitutes 
the  Femoral  Canal  of  Cloquet.  Afterwards,  if  the  hernia 
increase,  instead  of  continuing  to  descend,  it  turns  up- 
wards and  outwards,  towards  the  anterior  superior  spi- 
nous process  of  the  ilium.  From  this,  it  is  obvious,  that 
the  places  of  stricture  may  be:  First,  the  opening  in  the 
femoral  sheath  for  a lymphatic,  or  small  vein:  Secondly. 
Hey’s  Ligament;  and  Thirdly,  the  edge  of  Gimbernat’s 
Ligament,  which  looks  towards  the  iliac  vein.  Mr.  Col- 
les,  whose  opinions  are  entitled  to  the  utmost  respect, 
thinks  that  surgeons  err  in  regard  to  the  third  place,  and 
that  the  stricture  is  formed  there,  by  the  internal  margin 
of  the  commencement  of  the  sheath  of  the  femoral  vessels 
instead  of  by  Gimbernat’s  ligament.  He  says  that  this 
orifice  remains  with  a sharp  and  distinct  edge,  even  w hen 
Gimbernat’s  ligament  is  taken  completely  out  of  the  way, 
and  that  the  edge  of  Gimbernat’s  ligament,  supposed  to 
constitute  this  stricture,  stops  several  lines  short  of  the 
Crural  Ring.  A dissection  performed  in  the  manner 
that  he  recommends,  is  unquestionably  in  favour  of  his 
position. 

The  Anterior  Crural  Nerve  has  but  little  to  do  with  this 
dissection,  as  it  is  placed  beneath  the  fascia  iliaca,  and  is 
on  the  outside  of  the  artery. 


CONTENTS  OF  THE  ABDOMEN. 


199 


SECTION  IV. 


Of  the  Contents  of  the  Abdomen. 

For  common  examination,  a crucial  incision  through 
the  parietes  of  the  Abdomen,  from  the  sternum  to  the 
pubes  on  the  left  of  the  navel,  and  from  one  side  to  the 
other  on  a line  with  the  umbilicus,  but  a little  below  it, 
answers  very  well.  The  flaps  thus  made,  being  turned 
aside  and  kept  down,  the  viscera  of  the  abdomen  can  be 
easily  seen. 

1.  The  Liver,  is  in  the  Right  Hypochondriac  region:  it 
occupies  nearly  the  whole  of  it,  the  upper  part  of  the  Epi- 
gastric, and  the  right  superior  part  of  the  left  Hypochon- 
driac. The  fundus  of  the  gall  bladder  projects  from  its 
right  inferior  surface,  beyond  its  anterior  edge. 

2.  The  Stomach,  when  not  much  distended,  is  confined 
to  the  lower  half  of  the  Epigastric  region,  and  to  the  right 
inferior  part  of  the  left  Hypochondriac. 

3.  The  Spleen,  if  not  large,  recedes  so  much  into  the 
back  part  of  the  left  Hypochondriac,  that  to  be  seen  it 
must  be  drawn  out. 

4.  The  small  Intestines  lie  in  the  Umbilical,  Hypogastric, 
part  of  the  Iliac  regions,  and  also  in  the  Pelvis,  when  the 
viscera  of  the  latter  are  not  distended. 

5.  The 'Colon  begins  in  the  right  Iliac  region,  passes  up 
into  the  right  Lumbar  and  Hypochondriac  and  through  the 
upper  part  of  the  Umbilical,  or  the  lower  of  the  Epigas- 
tric, according  to  the  distention  of  the  stomach ; it  then 
gets  to  the  left  Hypochondriac,  being  commonly  higher 
up  in  it  than  in  the  right  Hypochondriac;  thence  it 
passes  into  the  left  Lumbar  and  Iliac,  forms  its  sigmoid 


200 


OF  THE  TRUNK. 


flexure,  and  dips  into  the  pelvis,  where  it  is  continuous  with 
the  rectum. 

6.  The  Omentum  Majus  is  in  front  of  the  small  intes- 
tines, and  most  frequently  found  gathered  up  in  the  Umbi- 
lical region.  If  it  be  not  diseased,  it  may  be  drawn  down- 
wards to  the  pelvis,  and  spread  out  so  as  to  conceal  all  the 
front  of  the  intestines. 

7.  The  Pancreas,  is  at  the  back  of  the  Epigastric  Re- 
gion, behind  the  stomach ; it  lies  horizontally,  and  extends 
from  the  right  of  the  spine  into  the  left  Hypochondriac 
region.  It  cannot  be  seen  without  cutting  through  the 
omentum  majus,  and  turning  the  stomach  upwards. 

8.  The  Kidneys  and  Capsulae  Renales,  are  in  the  Lumbar 
Regions,  at  their  back  parts.  They  should  not  be  sought 
for  at  this  stage  of  the  dissection. 

It  is  useful  to  know  that  the  position  of  the  viscera  of  the 
abdomen,  is  influenced  much  by  the  position  of  the  body, 
and  that  in  what  is  said  of  the  occupancy  of  the  regions,  it 
is  understood  that  the  subject  is  on  his  back.  When  one 
stands  upright,  the  lumbar  vertebrae  are  more  convex  in 
front,  and  the  abdomen  more  protuberant  below.  The 
pelvis  is  so  adjusted  that  the  acetabula  are  nearly  in  a ver- 
tical line  with  the  spine,  which  gives  great  obliquity  to  the 
superior  strait,  mounts  the  sacrum  up  on  high,  and  brings 
the  bodies  and  rami  of  the  pubes  not  many  degrees  from 
the  horizontal  line.  Most  of  the  viscera  descend,  but  more 
particularly  the  liver,  which  being  no  longer  sustained  by 
the  false  ribs,  and  being  influenced  by  its  heavy  inert  mass, 
may,  in  many  cases,  be  felt  externally  along  the  right  infe- 
rior margin  of  the  thorax.  This  descent  of  the  liver,  will 
be  according  to  the  degree  of  vacuity7  of  the  stomach,  in- 
testines, and  bladder. 

It  is  said  by  Winslow,  that  the  uneasiness,  pain,  and 
faintness  we  feel  in  a vacuity  of  the  stomach,  &c.,  from 
the  want  of  food,  arise  from  the  liver  drawing  the  dia- 
phragm downwards.  Portal  informs  us,  that  in  order  to 
ascertain  the  descent  of  the  liver  in  the  erect  posture,  he  has 
often  thrust  poignards  below  the  false  ribs  of  dead  bodies, 


CONTENTS  OF  THE  ABDOMEN. 


201 


and  that  he  has  invariably  found  the  wounds  much  -higher 
up,  than  when  they  were  inflicted  in  the  horizontal  posture. 

It  should  be  well  recollected,  that  the  abdominal  cavity  is 
always  full,  there  being  no  unoccupied  space  in  it;  hence, 
whenever  any  viscus  has  an  inordinate  growth,  or  a tumour 
forms  on  it,  or  an  effusion  occurs  in  the  peritoneal  cavity, 
the  other  viscera  are  encroached  upon.  In  a treatment  for 
sickness,  when  the  stomach  and  bowels  have  been  evacuated 
by  low  diet  and  purging,  air  supplies  the  place  of  more 
solid  matter,  and  keeps  them  distended.  It  is  indeed  ex- 
ceedingly rare  to  find  the  small  intestines  contracted;  in  the 
large,  it  is  more  common. 

Having  become  generally  informed  on  the  viscera  of  the 
abdomen,  by  repeated  handling,  we  should,  in  the  next 
place,  proceed  to  an  examination  of  their  forms  and 
structure. 

The  Peritoneum  is  a thin,  delicate,  semi-transparent 
membrane,  very  extensible,  and  spread  out  so  as  to  line  the 
cavity  of  the  abdomen,  and  give  an  external  covering  to 
the  greater  number  of  its  viscera.  In  man,  it  is  a complete 
sac,  having  no  hole  in  it ; but  in  woman,  its  cavity  commu- 
nicates externally  through  the  Fallopian  tubes.  It  has  a 
double  use ; in  consequence  of  covering  the  viscera,  it  is  so 
reflected  from  them  to  the  sides  of  the  abdomen,  that  its 
processes  keep  the  viscera  in  their  proper  places,  and  there- 
fore answer  as  ligaments.  Again,  its  internal  surface  being 
smooth,  highly  polished,  and  continually  lubricated  by  a 
thin  albuminous  fluid,  corresponding  with  the  synovial 
fluid  of  the  joints,  the  motions  which  the  viscera  have  upon 
each  other  in  exercise,  and  in  the  peristaltic  movements  of 
the  bowels,  are  much  facilitated. 

The  manner  in  which  a double  night-cap  is  applied  to 
the  head,  will  afford  the  easiest  conception  of  the  reflections 
of  the  peritoneum.  If  there  were  only  one  viscus  in  the 
belly,  and  that  of  a somewhat  regular  outline,  as  the  spleen, 
the  comparison  would  be  rigid,  and  perfectly  appreciable. 
One  part  of  the  cap  is  close  to  the  head,  and  compares  with 
the  peritoneal  coat  of  the  spleen ; the  other  is  loose,  and  is 
equivalent  to  the  peritoneum,  where  it  is  in  contact  with  the 
parietes  of  the  belly.  It  is  also  evident  from  this,  that  none 
of  the  viscera  can  be  said  to  be  within  the  cavity  of  the 


202 


OF  THE  TRUNK. 


peritoneum ; that  they  are  all  on  its  outside ; and  that  a 
viscus  in  getting  a coat  from  the  peritoneum,  merely  makes 
a protrusion  into  its  cavity.  Starting  with  this  most  simple 
proposition,  it  is  easy  to  conceive  of  a second,  a third  body, 
and  so  on,  deriving  an  external  coat  from  a protrusion  into 
the  same  sac.  Admitting  these  bodies  to  be  spheres,  the 
proposition  is  immediately  intelligible ; and  as  a last  step 
from  it,  the  idea  is  not  rendered  much  more  complex  by 
substituting  any  bodies,  even  the  most  irregular  in  form,  for 
these  spheres.  Such,  then,  is  the  fact  in  regard  to  the  sto- 
mach, intestines,  &c.;  they  all,  with  exceptions  to  be  stated, 
derive  an  external  coat  from  the  peritoneum. 

The  reflections  of  peritoneum  forming  the  ligaments  of 
the  liver,  will  be  best  described  in  connexion  with  that 
viscus.  Its  reflections  over  the  viscera  of  the  pelvis,  will 
be  described  with  them ; we  will  merely  say  for  the  present, 
that  it  covers  the  upper  and  back  part  of  the  urinary  blad- 
der, and  is  reflected  from  it  to  the  rectum. 

The  reflections  for  immediate  study,  are  the  Omenta, 
Fatty  Appendages  of  the  Colon,  the  Mesentery  and  the 
Mesocolon. 

There  are  four  Omenta.  Omentum  Minus  or  Hepatico- 
Gastricum,  Omentum  Majus  or  Gastro-Colicum,  Omentum 
Gastro-Splenicum,  and  Omentum  Colicum. 

1.  The  Omentum  Minus,  or  Hepatico  Gastricum,  ex- 
tends as  its  name  imports  between  the  liver  and  the  stomach. 
Beginning  at  the  transverse  fissure  of  the  liver ; it  passes 
from  the  lobulus  Spigelii,  at  the  posterior  half  of  the  umbili- 
cal fissure  and  from  the  tendinous  centre  of  the  diaphragm, 
to  the  lesser  curvature  of  the  stomach,  in  all  the  space  from 
die  cardiac  to  the  pyloric  orifice  and  the  duodenum.  It  is 
composed  of  two  laminae,  which,  near  the  stomach,  are 
separated  by  the  coronary  vessels.  It  has  always  but  an  in- 
considerable quantity  of  fat  in  it.  Its  right  margin  is  com- 
monly called  the  Capsule  of  Glisson,  and  contains  the  he- 
patic vessels. 

2.  The  Omentum  Majus,  or  Gastro-Colicum,  is  an  irregu- 
lar quadrilateral  membrane,  having  its  base  upwards.  The  lat- 
ter is  fixed  anteriorly  to  the  greater  curvature  of  the  stomach, 


CONTENTS  OF  THE  ABDOMEN. 


203 


and  posteriorly  to  the  transverse  arch  of  the  colon.  It  hangs 
loose  in  its  inferior  part,  and  is  sometimes  found  spread 
over  the  intestines  as  low  as  the  pelvis ; it  is,  therefore,  not 
improperly  compared  to  an  apron.  On  its  right  side,  it  is 
continued  into  the  omentum  colicum,  and  on  the  left  into 
the  gastro-splenicum.  It  consists  of  two  laminae,  the  an- 
terior is  fixed  to  the  stomach,  the  posterior  to  the  colon. 
Each  of  these  laminae  again  is  composed  of  two,  so  that  it 
may  be  compared  to  two  bags,  one  within  the  other,  con- 
nected at  their  upper  or  open  end  to  the  stomach  and  colon. 
The  internal  and  external  bags  are  very  separable  above, 
but  below  they  are  closely  united.  In  corpulent  subjects 
a great  deal  of  fat  is  found  in  this  membrane. 

By  searching  for  the  neck  of  the  gall-bladder,  we  shall 
find  near  it,  under  the  capsule  of  Glisson,  the  Foramen  of 
Winslow,  an  opening  which  conducts  into  the  sac  or  cavity 
of  the  omentum  majus.  It  is  large  enough  to  admit  easily 
two  fingers.  By  detaching  the  omentum  majus  from  the 
stomach,  and  turning  it  down,  we  shall  see  the  nature  of  its 
cavity,  its  extent,  and  all  the  parts  constituting  its  parietes. 
This  cavity  is  bounded  above  by  the  omentum  minus  and 
stomach  ; in  front  by  the  two  laminae  sent  from  the  stomach  ; 
behind  and  below,  by  these  laminae  being  reflected  upwards 
and  joining  the  colon,  and  posteriorly  and  above,  by  the 
upper  lamina  of  the  mesocolon,  which  is  extended  to  the 
Lobulus  Spigelii.  A little  reflection  will  show  that  I have 
described  an  uninterrupted  cavity,  beginning  at  the  lobulus 
spigelii  by  the  omentum  minus,  and  terminating  with  the 
lobulus  spigelii  by  the  upper  lamina  of  the  mesocolon.  It 
is  acknowledged  on  all  sides  to  be  one  of  the  most  obscure 
propositions  in  descriptive  anatomy,  even  when  the  subject 
is  before  a young  student.  It  is  a point  well  worth  master- 
ing, as  when  this  is  accomplished,  all  other  difficulties,  in 
studying  the  reflections  of  the  peritoneum,  are  much  di- 
minished. 


204 


OF  THE  TRUNK. 


A View  of  the  Reflections  of  the  Peritoneum,  as  given  by  a 
Vertical  Section  of  the  Body  of  a Man. 

Fig.  44. 


1.  A section  of  the  Spinal  Column  and  Canal. 

2.  A section  of  the  Sacrum. 

3.  A section  of  the  Sternum,  &c. 

4.  The  Umbilicus. 

5.  A section  of  the  Linea  Alba  and  Abdominal  Muscles. 

6.  The  Mons  Veneris. 

7.  Section  of  _the  Pubes. 

8.  The  Penis  divided  at  the  Corpora  Cavernosa. 

9.  A section  of  the  Scrotum. 

10.  The  Superior  Right  Half  of  the  Diaphragm. 

11.  A section  of  the  Liver. 

12.  A section  of  the  Stomach,  showing  its  cavity. 

13.  A section  of  the  Transverse  Colon. 


CONTENTS  OF  THE  ABDOMEN. 


205 


14.  A section  of  the  Pancreas. 

15.  A section  of  the  Bladder,  deprived  of  the  Peritoneum. 

16.  The  Rectum,  cut  off,  tied  and  turned  back  on  the  promontory  of 

the  Sacrum. 

17.  The  Peritoneum  covering  the  anterior  Parictes  of  the  Abdomen. 

18.  The  Peritoneum  on  the  inferior  under  side  of  the  Diaphragm. 

19.  The  Peritoneum  on  the  Convex  side  of  the  Diaphragm. 

20.  Reflection  of  Peritoneum  from  Diaphragm  to  Liver. 

21.  The  Peritoneum  on  Front  of  Liver. 

22.  The  same,  on  its  under  surface. 

23.  The  Hepato-Gastric  Omentum. 

24.  A large  pin  passed  through  the  Foramen  of  Winslow  into  the 

Cavity  behind  the  Omentum. 

25.  The  anterior  Face  of  the  Hepato-Gastric  Omentum,  passing  in 

front  of  the  Stomach. 

26.  The  same  Membrane  leaving  the  Stomach  to  make  the  anterior 

of  the  four  layers  of  the  Great  Omentum. 

27.28.  The  junction  of  the  Peritoneum  from  the  front  and  back  part  of 

the  Stomach,  as  they  turn  to  go  up  to  the  Colon. 

29.  The  Gastro-Colic,  or  Greater  Omentum. 

3d.  The  separation  of  its  Layers,  so  as  to  cover  the  Colon. 

31.  The  posterior  Layer  passing  over  the  Jejunum. 

32.  The  Peritoneum  in  front  of  the  right  Kidney. 

33.  The  Jejunum  cut  off"  and  tied. 

34.34.  The  Mesentery  cut  off  from  the  small  Intestines. 

35.  The  Peritoneum  reflected  from  the  posterior  Parietes  of  the  Blad- 

der to  the  anterior  of  the  Rectum. 

36.  The  Cul  de-Sac  between  the  Bladder  and  Rectum. 

3.  The  Omentum  Colcicum,  is  a prolongation  of  the 
omentum  majus,  from  the  internal  side  of  the  right  ascend- 
ing colon,  and  from  the  adjacent  part  of  the  transverse.  It 
is  tilled  with  fat  from  the  same  causes  as  the  preceding,  but 
consists  of  only  two  single  laminae. 

4.  The  Omentum  Gastro-Splenicum,  is  that  process  of 
peritoneum,  which  extends  from  the  large  extremity  of  the 
stomach  to  the  spleen  ; it  may  be  considered  as  the  left 
flank  or  prolongation  of  the  omentum  majus,  and  encloses 
in  its  duplicature  the  arteries  and  veins  called  Vasa  Brevia. 

5.  The  Appendiculte  Epiploicte,  are  little  processes  of 
peritoneum,  filled  with  fat,  appended  at  irregular  intervals 
to  the  anterior  sides  of  the  caecum,  colon,  and  the  upper 
part  of  the  rectum. 

The  Mesentery,  is  a process  of  peritoneum  which  is 
extended  obliquely  across  the  spine,  from  a line  parallel 
with  the  second  lumbar  vertebra,  to  the  right  iliac  fossa. 
This  part,  called  its  root  in  the  adult,  is  about  six  inches  in 


206 


OF  THE  TRUNK. 


length  and  flat,  but  the  inferior  edge  which  is  loose  and 
pendulous,  having  the  intestines  connected  with  it,  has  its 
circumference  increased  to  many  feet,  being  the  whole  length 
of  the  small  intestines,  with  the  exception  of  the  duodenum. 
The  mesentery  attaches  the  left  extremity  of  the  small  intes- 
tines to  the  spine.  It  consists  of  two  laminae  of  peritoneum 
separated  by  the  mesenteric  arteries  and  veins,  the  lacteal 
glands  and  vessels,  and  the  nerves  derived  from  the  solar 
plexus.  There  is  also  some  fat  between  them. 

The  Mesocolon,  fixes  the  large  intestine  to  the  back  of 
the  abdomen.  The  posterior  part  of  the  caecum  is  in  con- 
tact with  the  iliac  fascia,  and  is  tied  down  to  it.  The  colon 
in  the  right  and  left  lumbar  regions,  is  also  for  the  most  part 
immoveably  fixed,  the  mesocolon  being  there  of  very  little 
length ; but  the  transverse  mesocolon  is  long,  and  forms  a 
complete  and  moveable  partition  between  the  upper  and 
the  lower  parts  of  the  abdomen,  which  permits  the  colon  to 
ascend  and  descend  according  to  the  distention  of  the  small 
bowels  and  stomach.  In  the  left  iliac  region  the  mesocolon 
is  elongated  so  much,  as  to  allow  very  free  motion  to  the 
sigmoid  flexure  of  the  gut,  and  is  continued  into  the  meso- 
rectum. 


OF  THE  VENTRICULUS,  OR  STOMACH. 

The  Stomach  is  a conoidal  sac,  curved  considerably  up- 
wards. As  was  stated,  it  is  in  the  epigastric  region,  in  con- 
tact above  with  the  diaphragm,  with  the  left  lobe  of  the 
liver  and  the  lobulus  spigelii ; on  the  left  with  the  spleen; 
behind  with  the  pancreas;  and  below  with  the  colon  and 
mesocolon.  The  stomach  has  a very  great  obliquity  in  its 
situation,  the  right  extremity  being  much  lower  down  than 
the  left. 

The  exterior  of  the  stomach  presents  two  faces,  two  or;- 
fices,  two  curvatures,  and  two  extremities. 

When  the  stomach  is  nearly  empty,  it  becomes  somewhat 
flattened,  and  then  exhibits  the  Anterior  and  the  Posterior 
face ; in  a state  of  distention,  the  first  looks  obliquely  up- 
wards, and  the  latter  obliquely  downwards.  The  angle, 


CONTENTS  OF  THE  ABDOMEN. 


207 


formed  with  the  oesophagus,  is  increased  according  to  the 
degree  of  distention. 

The  orifices  are  named  Pyloric  and  Cardiac.  The  Py- 
loric, viewed  externally,  presents  nothing  remarkable,  but 
seems  to  be  a continuation  of  the  right  extremity  of  the 
stomach  into  the  duodenum.  The  Cardiac,  formed  by  the 
junction  of  the  oesophagus  with  it,  is  at  the  upper  edge  of 
the  stomach,  and  some  distance  from  the  extreme  left. 

The  curvatures  are  the  Great  and  Small.  The  first  in- 
cludes the  great  extremity  and  the  inferior  edge  of  the  sto- 
mach to  the  pylorus;  the  small  is  the  upper  margin  be- 
tween the  orifices. 

The  Tuber  or  great  extremity  of  the  stomach,  is  the  part 
to  the  left  of  the  vertical  plane,  passing  through  the  cardiac 
orifice ; it  is  smaller  in  proportion  in  children  than  in 
adults. 

The  stomach  is  formed  by  four  coats  or  laminae,  the  Pe- 
ritoneal, Muscular,  Cellular,  and  Mucous.  The  external  is 
Peritoneal,  and  derived  from  the  separation  of  the  two  la- 
minae of  the  omentum  minus.  The  second  is  Muscular,  its 
thickness  is  inconsiderable,  and  the  fibres  which  compose 
it  are  remarkably  pale ; they  are  best  seen  near  the  cardia 
and  at  the  pylorus.  At  the  latter,  they  are  collected  into  a 
ring  of  considerable  thickness,  which,  making  a marked 
prominence  internally,  helps  to  constitute  the  valve  of  the 
pylorus.  The  muscular  fibres  go  in  three  directions. 
The  first  being  longitudinal,  are  continued  from  similar 
ones  of  the  oesophagus  and  extend  to  the  pyloric  orifice. 
The  principal  part  of  them  is  collected  into  two  bands,  the 
thicker  of  which  passes  along  the  lesser  curvature,  and -the 
thinner  along  the  greater.  The  second  set  of  muscular 
fibres,  surrounds  the  stomach  by  segments  of  circles,  none 
of  them  going  completely  around.  It  is  this  set,  in  an  espe- 
cial manner,  which  assists  in  forming  the  pyloric  orifice. 
The  third  and  most  profound  set  of  muscular  fibres,  some- 
times spoken  of  as  the  muscle  of  Gavard,  is  oblique,  and 
forms  two  large  bands.  One  is  extended  from  the  left  side 
of  the  cardia  over  the  anterior  and  posterior  faces  of  the 
stomach  ; and  the  other  is  prolonged  from  the  right  side  of 
the  same  orifice  over  the  great  extremity  also  before  and 
behind,  where  it  supplies  the  scarcity  of  transverse  or  cir- 
cular fibres.. 


208 


OF  THE  TRUNK. 


The  third  coat  of  the  stomach,  consists  of  a very  dense 
compact  short  cellular  membrane,  which  unites  the  muscu- 
lar and  internal  coat,  and  conducts  the  vessels  and  nerves 
to  the  latter. 

The  fourth,  or  Internal  Coat  of  the  stomach,  called  also 
the  Mucous  or  Villous,  is  of  a light  red  colour,  about  a line 
in  thickness,  and  can  be  easily  raised  up  by  dissection.  It 
is  like  velvet,  and  thrown  into  very  irregular  folds,  accord- 
ing to  the  degree  of  contraction  of  the  stomach.  At  the 
pyloric  orifice,  it  forms  a circular  fold  constituting  the  pyloric 
valve,  and  having  a round  hole  in  the  centre.  At  the  base 
of  this  valve,  the  muscular  fibres  make  a distinct  ring.  The 
stomach  is  supplied  with  blood,  by  the  Gastric,  Right  and 
Left  Gastro-Epiploic  Arteries,  and  by  the  Vasa  Brevia.  The 
veins  follow  the  course  of  the  arteries,  and  terminate  di- 
rectly or  indirectly,  in  die  Vena  Portarum. 

OF  THE  INTESTINAL  CANAL. 

This  Canal  is  from  thirty  to  thirty-five  feet  long  in  the 
human  subject,  and  extends  from  the  Pylorus  to  the  Anus. 
It  consists  of  two  portions,  which,  owing  to  a well  marked 
difference  in  magnitude,  is  divided  by  anatomists  into  the 
Small  and  Large  intestines,  the  former  forming  four-fifths  of 
the  whole,  extends  from  the  stomach  to  the  ileo-colic  valve, 
die  latter  from  this  valve  to  the  anus.  This  canal,  like  the 
stomach,  consists  of  four  coats,  peritoneal,  muscular,  cellular, 
and  mucous. 

The  Small  Intestine,  or  Intestinum  Tenue,  although  an 
uninterrupted  tube,  is  diiided  somewhat  artificially,  for  the 
sake  of  description,  into  three  parts,  Duodenum,  Jejunum, 
and  Ileum. 

The  Duodenum,  named  from  its  length,  which  has  been 
fixed  at  twelve  fingers  breadth,  is  nearest  the  stomach,  and 
the  commencement  of  the  canal.  It  is  also  called  A entri- 
culus  Succenturiatus.  Beginning  at  die  pylorus,  it  passes 
upwards,  and  to  the  right  side,  till  it  reaches  the  neck  of  the 
gall-bladder;  it  then  forms  a right  angle,  and  passes  down- 


CONTENTS  OF  THE  ABDOMEN.  209 

wards  before  the  right  kidney,  to  the  third  lumbar  vertebra, 
being  there  placed  behind  the  superior  lamina  of  the  transverse 
Mesocolon.  Here  it  forms  a round  elbow,  and  crosses  the 
spine  obliquely  upwards,  under  the  junction  of  the  mesen- 
tery and  mesocolon,  and  makes  its  appearance  to  the  left 
of  the  second  lumbar  vertebra,  where  it  is  continued  into 
the  mesenteric  portion  of  intestine. 

The  head  of  the  Pancreas  lies  in  the  bend  of  the  duode- 
num, and  fixes  it  firmly  just  there.  The  first  part,  where 
it  emanates  from  the  pylorus,  is  moveable,  and  covered  with 
peritoneum  ; the  second  and  third  portions  are  between  the 
laminae  of  the  mesocolon,  but  have  no  peritoneal  coat ; and 
the  termination  is  both  moveable,  and  has  a peritoneal  coat 
from  being  at  the  commencement  of  the  mesentery.  The 
partial  deficiency  of  peritoneal  coat,  is  said  to  be  the  cause 
why  the  duodenum  is  susceptible  of  an  enlargement,  in 
some  cases,  but  little  inferior  to  the  stomach. 

The  muscular  coat  of  this  intestine  consists  of  two  planes 
of  fibres,  the  external  one  longitudinal,  the  other  circular 
and  much  the  most  numerous.  Beneath  is  the  cellular  coat, 
connecting  it  with  the  mucous  or  villous  coat.  This  internal 
coat  is  reddish,  tinged  with  bile,  and  occupied  by  a great 
number  of  rugae  or  folds.  They  are  transverse  and  oblique, 
very  near  each  other,  about  three  lines  broad,  and  as  pro- 
minent in  the  distended  as  the  undistended  gut;  these  con- 
stitute the  Valvulae  Conniventes.  Many  mucous  follicles 
exists  in  this  intestine,  and  mucous  glands,  called  Glands  of 
Brunner ; the  latter  are  particularly  accumulated  about  the 
pyloric  orifice.  It  is  in  the  posterior  part,  about  four 
inches  from  the  stomach,  that  the  orifices  of  the  pancreatic 
and  hepatic  ducts  are  found. 

The  Inferior,  or  Mesenteric  portion  of  the  Intestinum 
Tenue,  has  the  same  coats  with  the  preceding.  In  the 
upper  two-fifths,  called  Jejunum,  by  Galen,  from  a supposi- 
tion that  it  was  most  frequently  found  empty,  the  valvulm  con- 
niventes are  numerous,  and  arranged  transversely ; but  in  the 
lower  three-fifths,  called  Ileum,  they  gradually  diminish, 
and  near  its  termination,  cease  entirely.  There  is  a gradual 
diminution  of  the  diameter  of  this  intestine  from  above 
downwards.  From  the  length  of  the  mesentery,  great  lati- 
tude of  motion  is  allowed  to  it.  It  presents  a very  irregular 
and  confusing  appearance  at  first,  but  one  soon  becomes 
14 


210 


OF  THE  TRUNK. 


accustomed  to  its  course  and  convolutions ; and  then  its 
commencement  and  termination,  are  as  readily  found  as  those 
of  any  other  organ.  It  is  probable  that  in  the  distentions 
of  this  bowel,  the  peritoneal  coat  does  not  stretch  much, 
as  the  laminee  of  mesentery  are  loosely  applied  against  each 
other  where  they  join  the  intestine,  and  are  separated  in  its 
distentions,  as  far  as  the  first  row  of  the  mesenteric  arches 
of  blood-vessels.  Cases  are  reported,  in  which  it  has  had 
appendiculse  epiploicse  and  cul-de-sacs  projecting  from  its 
sides.  I have  never  seen  the  former,  but  of  the  latter,  a 
specimen  was  presented  to  me  some  years  ago,  taken  from 
a child,  by  the  late  Dr.  Edward  Barton  ; and  another  speci- 
men now  belongs  to  the  Wistar  Museum,  obtained  in  the 
dissecting  rooms. 

The  mucous  or  internal  coat  of  the  Intestinum  Tenue, 
differs  from  that  of  the  stomach,  in  resembling  more  the 
downy  cuticle  of  an  unripe  peach.  The  little  projections 
from  it,  are  called  Villi.  It  abounds  with  mucous  follicles 
and  glands;  the  latter  consist  in  those  of  Brunner,  which 
are  insulated  from  each  other  and  may  be  seen  at  intervals 
along  the  whole  intestine : and  in  those  of  Peyer,  which 
make  about  thirty  patches  of  an  elliptical  shape  and  of  va- 
rious sizes,  towards  the  lo’wer  end  of  the  Ileum.  The  small 
intestine  is  supplied  with  blood  from  the  superior  mesenteric 
artery.  Its  nerves  come  from  the  Sympathetic. 

The  course  of  the  large  Intestine  or  the  Intestinum  Cras- 
sum,  has  already  been  explained.  It  is  more  obviously  a 
conical  tube  than  the  small  intestine,  being  very  large  at  its 
commencement  when  inflated,  and  diminishing  much  to  the 
lower  end.  of  the  sigmoid  flexure.  Anatomists  call  its 
commencement,  or  that  part  below  the  ileo-colic  valve,  Cjf,- 
cum  or  Caput  Coli ; and  the  remaining  portion,  which  is 
by  far  the  longest,  the  Colon,  until  it  reaches  the  pelvis, 
when  it  becomes  Rectum. 

The  CmcuM,  or  Caput  Coli,  is  aibout  two  inches  in  length, 
and  is  fixed  to  the  iliac  fascia  by  peritoneum  and  loose  cel- 
lular membrane.  At  its  inferior  extremity,  towards  the 
left,  is  the  Appendicula,  Vermiformis,  a blind,  cavity  of  four 
coats,  about  four  inches  long,  and  of  the  size  of  a turkey 
quill,  enclosed  in  a duplicature  of  peritoneum.  It  floats 
loose,  and  occasionally  becomes  a cause  of  mischief,  by 
getting  around  the  ilium,  and  inflaming,  by  which  it  adheres 


CONTENTS  OF  THE  ABDOMEN. 


211 


and  produces  in  some  measure,  strangulation.  The  colon 
makes  a large  sweep  around  the  abdomen,  and  in  passing 
under  the  gall-bladder,  touches  it,  and  thus  becomes  tinged 
with  bile  after  death.  In  its  transverse  course,  we  fre- 
quently find  it  passing  through  the  umbilical  region. 

The  coats  of  the  Intestinum  Crassum,  correspond  in  num- 
ber with  those  of  the  small  intestine ; but  there  are  some 
differences  in  structure.  The  longitudinal  muscular  fibres 
are  much  more  conspicuous ; they  are  collected  into  three 
bands,  which  commence  at  the  head  of  the  colon,  and  ex- 
tend to  the  upper  part  of  the  rectum;  one  is  superior,  an- 
other inferior,  and  a third  anterior.  They  are  equidistant 
from  each  other.  These  longitudinal  bands  produce  the 
cells  of  the  colon,  in  consequence  of  being  shorter  than  the 
other  coats  of  the  gut,  and  puckering  them  up  by  drawing 
its  extremities  nearer  together.  The  cells  are  separated 
laterally,  by  partitions  or  buttresses,  formed  of  a doubling  of 
all  the  coats  of  the  intestine ; whereas  in  the  small  intestine, 
the  valvulse  conniventes  or  doublings  belong  exclusively  to 
the  mucous  membrane.  These  cells  are  not  so  numerous 
or  well  formed  in  the  sigmoid  flexure  and  thereabouts  ; the 
channel  is  therefore  more  open  and  unobstructed.  By  di- 
viding these  longitudinal  bands,  the  cells  are  removed,  and 
the  intestine  elongated  considerably. 

The  Ileo-Colic  Valve,  or  valve  of  Bauhin,  or  Tulpius, 
is  a great  curiosity  in  the  anatomical  structure  of  this  gut. 
The  ileum  runs  into  the  left  side  of  the  colon,  and  continues 
its  cellular  and  mucous  coat  into  the  corresponding  coats  of 
the  colon,  the  muscular  coat  of  the  latter  being  simply 
parted.  To  prevent  the  farther  separation  of  the  muscular 
fibres,  a little  ligamentous  arrangement,  called  the  Retina- 
culum of  Bauhin  or  Morgagni,  prevails  at  each  end.  When 
viewed  from  within  the  colon,  the  opening  appears  as  a 
transverse,  or  very  narrow  elliptical  slit,  established  by  two 
lips,  the  superior  being  broader  than  the  inferior.  They 
meet  like  the  gates  of  the  common  ship- dock  or  hydraulic 
lock ; and  from  being  placed  transversely,  in  regard  to  the 
cavity  of  the  intestine,  every  distention  which  the  latter  may 
suffer  from  the  accumulation  of  faeces,  has  a tendency  to 
force  this  valve,  and  will,  by  stretching  its  extremities,  make 
the  lips  tighter  and  more  resisting. 

The  internal  coat  of  the  large  intestine  differs  very  mate- 
rially from  that  of  the  small..  It  has  no  doublings  or  folds 


212 


OF  THE  TRUNK. 


exclusively  in  it,  like  the  valvulm  conniventes  of  the  small 
intestines,  and  few  or  no  villi.  Near  its  commencement,  it 
preserves  the  fungous  appearance  of  the  stomach,  but  about 
the  sigmoid  flexure,  it  is  a plain  smooth  surface.  A great 
many  mucous  follicles  and  mucous  glands  are  in  it.  It  has 
lacteals,  but  they  are  not  so  numerous  as  in  the  small  in- 
testines. 

The  Rectum  will  be  described  with  the  Pelvis. 

OF  THE  LIVER,  (HEPAR,  SIVE  JECUR.) 

The  Liver  secretes  the  bile,  and  is  the  largest  glandular 
body  in  the  human  frame.  Its  position  in  the  abdomen  and 
the  space  it  occupies,  have  been  mentioned.  It  is  placed  in 
the  following  relations,  with  neighbouring  parts.  Above, 
it  is  in  contact  with  the  concavity  of  the  diaphragm ; below, 
it  has  the  Omentum  Minus,  the  Stomach,  and  the  Trans- 
verse Arch  of  the  Colon ; and  behind,  is  the  Vertebral 
Column,  intercepted,  however,  by  the  lesser  muscle  of  the 
diaphragm,  and  the  Ascending  Cava.  When  we  lie  on  the 
right  side,  it  is  sustained  by  the  ribs  in  the  easiest  posture ; 
when  on  the  left,  it  sometimes  occasions  uneasiness  by  press- 
ing on  the  stomach ; and  when  on  the  back,  it  compresses 
the  ascending  cava. 

The  liver,  from  being  completely  enveloped  in  perito- 
neum, has  a smooth,  glossy  appearance,  and  is  of  a red- 
dish-brown colour.  Its  form  is  happily  compared,  by  Pro- 
fessor Chaussier,  to  the  section  of  an  ovoid,  made  in  the  di- 
rection of  its  greatest  diameter,  the  thick  end  being  to  the 
right  side.  It  is  fastened  in  its  situation  by  the  following 
reflections  of  the  peritoneum.  From  the  centre  of  the  dia- 
phragm, and  extending  from  the  umbilicus  backwards  to 
near  the  ascending  cava,  is  the  Falciform  or  Suspensory 
Ligament,  consisting  of  two  laminae ; it  is  thickened  at  its  an- 
terior edge  by  what  was  once  the  umbilical  vein  in  the  foetus, 
but  is  now  converted  into  afibrous  substance  called  the  Round 
Ligament.  This  falciform  ligament,  divides  the  upper  sur- 
face of  the  liver  unequally  into  two,  the  left  being  the 
smaller ; it  also  penetrates  a notch  in  the  anterior  edge  ol 
the  liver.  On  the  right  of  the  falciform  process,  and  ex- 
tending from  the  diaphragm  to  .the  posterior  edge  of  the 
liver,  is  the  Right  Lateral  Ligament ; to  the  left  of  the  same 
process,  and  also  extending  from  the  diaphragm  to  the  back 


CONTENTS  OF  THE  ABDOMEN. 


213 


edge  of  the  liver,  is  the  Left  Lateral  Ligament ; and  that 
portion  of  peritoneum  concerned  in  describing  the  periphery 
of  this  space,  constitutes  the  Coronary  Ligament.  Within 
the  circumference  of  the  coronary  ligament,  the  surface  of 
the  liver  is  not  covered  by  peritoneum,  but  is  attached  to 
the  diaphragm  by  loose  cellular  substance. 

The  precise  shape  of  the  liver,  is  best  seen  in  one  re- 
moved from  the  body.  The  following  parts  are  noticed  by 
anatomists : its  upper  surface,  its  lower  surface,  its  right  ex- 
tremity, its  left  extremity,  its  anterior  edge  and  its  posterior 
edge. 

The  upper  surface  is  uniformly  convex,  adapts  itself 
readily  to  the  concavity  of  the  under  surface  of  the  Dia- 
phragm, and  presents  nothing  remarkable,  but  its  equal  di- 
vision by  the  suspensory  ligament. 

The  lower  surface  is  very  irregularly  concave,  and  on  it 
are  the  following  appearances : From  the  front  to  the  back 
edge,  it  is  traversed  by  a deep  fissure,  corresponding  in  situa- 
tion with  the  attachment  of  the  suspensory  ligament  above, 
and  with  it,  giving  occasion  to  divide  the  liver  into  Right 
and  Left  lobes.  This  is  the  Sulcus  Umbilicalis,  or  umbilical 
fissure,  occupied  in  front  by  what  was  the  umbilical  vein, 
and  in  the  rear  by  wThat  was  the  ductus  venosus,  both  ves- 
sels in  the  adult  being  in  a ligamentous  state.  Crossing  this 
fissure  at  right  angles,  passing  from  the  left  lobe,  for  some 
distance  into  the  right,  and  occupying  about  the  middle 
third  or  fourth  of  the  long  diameter  of  the  liver,  is  the  Sul- 
cus Transversalis,  or  Transverse  Fissure.  In  it,  are  the 
vena  portarum,  hepatic  artery,  and  ducts,  lymphatics  and 
nerves,  all  of  which  are  bound  to  each  other  by  a close  cellular 
substance.  The  Lobulus  Spigelii  or  posterior  lobe,  is  placed 
at  the  back  of  the  liver,  just  to  the  right  of  the  posterior 
part  of  the  sulcus  umbilicalis.  It  is  like  a ridge,  and  termi- 
nates forwards  in  a papilla  which  is  one  of  the  portm  of  the 
liver ; to  the  right,  the  lobulus  spigelii  sends  off  a small 
process,  which  unites  it  with  the  greater  lobe  of  the  liver, 
and  is  called  the  Lobulus  Caudatus.  On  the  front  of  the 
inferior  surface,  between  the  fore  part  of  the  umbilical  fissure 
and  the  gall-bladder,  is  a flat  rising,  the  Lobulus  Anonymus 
or  Quartus  ; its  posterior  extremity,  opposite  to  the  anterior 
of  the  lobulus  spigelii,  is  the  second  gate-way  or  porta  of 
the  liver. 


214 


OF  THE  TRUNK. 


The  right  extremity  of  the  liver  is  very  thick  and  almost 
fills  the  right  hypochondriac  region,  but  the  left  tapers  to  a 
very  thin  edge.  The  posterior  border  or  edge,  is  thick  and 
indented  by  the  spine,  but  the  anterior  edge  is  thin.  The 
former  is  sometimes  converted  into  a complete  canal,  marked 
by  a short  large  sulcus  for  the  ascending  vena  cava ; the 
latter  only  has  the  notch  for  the  suspensory  ligament  already 
mentioned. 

Besides  the  peritoneal  coat,  the  liver  has  a second,  which 
covers  its  whole  exterior  surface,  adhering  very  closely  to 
the  peritoneum  on  one  side,  and  to  the  liver  on  the  other; 
it  penetrates  into  the  substance  of  the  liver,  and  holds  to- 
gether its  granulated  structure.*  This  tunic  is  easily  seen 
by  stripping  off  the  peritoneum,  or  in  parts  which  naturally  are 
left  uncovered  by  the  latter,  as  within  the  circle  of  the  coro- 
nary ligament. 

The  blood-vessels  are  of  three  kinds.  The  first  two 
bring  the  blood  to  the  liver;  the  third  takes  it  away,  by  empty- 
ing into  the  ascending  cava.  The  Hepatic  Artery,  a branch 
of  the  coeliac,  after  having  detached  some  smaller  ramifica- 
tions, gets  to  the  transverse  fissure  of  the  liver  and  divides 
into  three  branches ; one  to  the  right  lobe,  one  to  the  left 
lobe,  and  another  to  the  lobulus  Spigelii ; they,  however, 
subdivide  before  they  reach  the  substance  of  the  liver. 
These  branches  are  between  the  sinus  portarum  and  the 
biliary  ducts. 

The  Vena  Portarum  being  formed  from  the  union  of  all 
the  veins  of  the  intestines,  stomach,  pancreas,  and  spleen, 
forms  a single  trunk  about  three  inches  long.  It  gets  to  the 
transverse  fissure  of  the  liver,  over  the  duodenum  and 
under  the  pancreas,  and  immediately  sends  off,  at  right  an- 
gles, two  branches  which,  collectively,  are  called  the  Sinus 
of  tbe  Vena  Portarum.  The  right  branch,  being  tire  shortest 
and  largest,  is  distributed  to  the  great  right  lobe;  the  left 
sends  its  branches  to  the  left  lobe,  lobulus  spigelii,  and  ano- 
nymus. 


See  Soemmering’s  Anatomy.  Laennec’s  Journal  de  Medecine. 


CONTENTS  OF  THE  ABDOMEN. 


215 


Fig.  45. 


2 


2 


A Horizontal  Section  of 

THREE  SUPERFICIAL  Lo- 
BULES  OF  THE  LlVER, 
SHOWING  THE  TWO  PRIN- 


2 CIPAL  SYSTEMS  OF  BLOOD* 


VESSELS. 


] .1.  Intra-Lobular  Veins  pro- 
ceeding from  the  He- 
patic Veins. 


2.2.  Intra-Lobular  Plexus 
formed  by  branches  of 
the  Portal  Veins. 


2 


At  the  bottom  of  the  transverse  fissure  is  a lamellated 
fibrous  cellular  tissue,  closely  adhering  to  the  liver,  which 
accompanies  the  vena  portarum,  the  hepatic  artery,  and  he- 
patic duct  in  their  ramifications,  forming  sheaths  for  them  as 
they  go  off  successively.  As  the  branches  of  these  tubes  keep 
together,  they  are  united  by  the  cellular  sheaths,  which  may- 
be considered  as  continuous  with  the  processes  sent  in  from 
the  cellular  coat.  Glisson  believed  these  sheaths  to  be  mus- 
cular, and  they  have  obtained  the  name  of  his  capsule,  al- 
though subsequent  examination,  has  proved  him  to  have  been 
in  error.  This  capsule  is  frequently  spoken  of  as  lying 
on  the  aforementioned  vessels,  even  before  they  reach 
the  liver.  The  Hepatic  Veins  arise  in  the  acini,  from  the 
capillary  extremities  of  the  hepatic  artery,  and  vena  por- 
tarum. There  are  three  principal  trunks  of  them,  coming, 
two  from  the  right  and  one  from  the  left  lobe  of  the  liver, 
and  emptying  into  the  ascending  cava,  just  below  the  dia- 
phragm ; there  are  also,  five  or  six  little  trunks,  coming 
from  the  posterior  surface  of  the  liver,  and  the  lobulus  spi- 
gelii,  which  empty  into  the  ascending  cava  below  the  other. 
The  hepatic  veins  have  no  valves,  and  may,  in  a section  of 
the  liver,  be  readily  distinguished  from  other  vessels  by 
their  lonely  course,  by  their  crossing  the  others  at  right 
angles,  and  by  their  thinness.  All  of  these  vessels  of  the 
liver  are  remarkable  for  the  number  of  their  anastomoses, 


216 


OF  THE  TRUNK. 


and  the  facility  of  their  communication  with  each  other.  A 
minute  injection  of  either,  pervades  all  parts  of  the  liver, 
and  the  injection  if  persevered  in,  will  fill  all  the  other  ves- 
sels. By  tearing  the  substance  of  the  liver,  a good  view  of 
its  organization  may  be  obtained ; it  will  then  be  seen  to  be 
composed  of  an  immense  number  of  spherical,  or  polyhe- 
drous  grains,  called  acini  from  their  resemblance  to  berries. 
These  are  united  to  each  other  by  the  cellular  tissue  of  the 
internal  coat,  and  traversed  by  blood  vessels.  Each  of 
these  grains  is  a representative  of  the  gland,  as  its  structure 
is  complete  in  itself,  being  formed  by  the  terminations  of  the 
blood  vessels,  and  by  the  origin  of  a branch  of  the  hepatic 
artery,  called  the  porus  biliarius.  When  examined  with  a 
microscope,  these  acini  are  observed  to  be  composed  of  a 
yellow  and  brownish  substance,  the  yellow  being  the  corti- 
cal portion. 

The  commencing  radicles  or  ramifications  of  the  Hepatic 
Duct,  take  their  origin  in  the  acini,  and  as  is  said,  upon  the 
boundary  between  the  two  kinds  of  matter,  avoiding  the 
brown,  and  passing  through  the  yellow  or  cortical.  The 
larger  branches,  converge  into  their  respective  trunks  suc- 
cessively, or  in  pairs,  while  several  of  the  primordial  or 
most  minute  ones  converge  to  the  same  point,  giving  a pen- 
icillous  appearance.  These  several  tubes,  constitute  the 
Pori  Billiard,  and  are  always  in  the  same  group  with  the 
branches  of  tire  Vena  Portarum,  and  Hepatic  Artery.  It  is 
unsettled,  whether  these  brush  like  or  penieillous  ends  of 
the  pori  billiard,  arc  enlarged  at  their  free  extremities,  so  as 
to  be  there  like  a pin  at  its  head,  in  the  manner  so  common 
in  glandular  structures.  Krause  asserts  the  fact,  and  states 
that  the  enlargement  measures  from  5V  to  gV  of  an  English 
line,  and  there  are  said  to  be  preparations  of  tire  kind  at 
Utrecht.  It  is  asserted,  that  a fine  injection  passes  more 
readily  from  them  into  the  lymphatics,  than  into  any  other 
order  of  vessels:  which  may  account  for  the  promptitude  of 
jaundice,  upon  any  obstruction  of  the  hepatic  duet. 

According  to  the  observations  of  Mr.  Kiernan,  the  acini 
of  anatomists  generally,  should  be  called  lobules,  inasmuch 
as  they  consist  in  a collection  of  smaller  granulated  bodies, 
to  which  he  restricts  the  name  of  acini.  The  principal  ob- 
jection to  this  is,  the  introduction  of  a new  definition  on  a 


COKTEiVTS  OF  THE  AEDOMF.N. 


217 


point  heretofore  considered  as  settled  in  the  universal  phra- 
seology of  anatomists,  but  as  his  descriptions  are  founded 
on  this  assumption,  it  may  for  the  time  be  admitted.  His 
statement  is,  that  the  finer  branches  of  the  vena  portarum, 
which  he  calls  Interlobular  Veins,  form  a perfect  and  minute 
plexus,  surrounding  the  lobules,  or  small  granular  masses  of 
the  liver:  they  there  form  convergent  lines  of  vessels  directed 
towards  the  centre  of  each  lobule,  and  communicating  by 
transverse  branches  with  one  another.  These  latter  con- 
nexions, or  the  sets  of  veins  making  them,  constitute  the 
lobular  venous  plexus,  and  in  their  intervals  are  placed  what 
he  calls  the  acini  or  subordinate  granules.  He  farther  states, 
that  the  Hepatic  Duct  forms  a plexus  upon  the  lobules  like 
that  of  the  vena  portarum ; the  plexuses  of  the  contiguous 
lobules  being  indisposed  to  anastomose,  though  he  thinks 
there  is  ground  to  believe  in  such  anastomosis.  The  inter- 
lobular biliary  ducts,  there  penetrate  the  lobule,  and  ramify 
by  anastomotic  connexion  through  it.  The  Hepatic  Artery 
also  makes  a plexus  upon  the  surface  of  the  lobule,  and 
penetrates  interiorly,  from  its  periphery,  towards  the  cen- 
tre. Its  ultimate  branches  supply  the  meshes  of  the  vena 
portarum,  of  the  vena  hepaticse,  and  of  the  biliary  ducts,  but 
their  final  termination  is  unsettled.  Kiernan  believes  that  it 
is  in  the  vena  portarum,  and  Meckel,  that  they  end  in  the 
incipient  branches  of  the  venae  hepaticse. 

The  Hepatic  Veins,  according  to  Mr.  Kiernan,  are  seen 
as  a small  trunk,  in  the  centre  of  a lobule : this  trunk 
arises  from  the  convergence  of  from  four  to  eight  venules, 
from  the  periphery  to  the  centre  of  the  lobule.  The  trunks 
having  escaped  each  from  its  respective  lobule,  there  unite 
with  contiguous  trunks  similarly  circumstanced,  and  as  the 
arrangement  is  progressive,  by  the  successive  junction  of 
larger  and  larger  trunks,  we  have  finally  the  large  Hepatic 
Veins  formed,  which  discharge  into  the  ascending  vena 
cava. 


218 


OF  THE  TRUNK. 


A Horizontal  Section  of  two  Superficial  Lobules,  showing  the 
Intra-Lobular  Plexus  of  Biliare  Ducts. 

Fig.  46. 


1.1.  Intra-Lobular  Veins. 

2.2.  Trunks  of  Biliary  Ducts,  proceeding  from  the  Plexus  which  tra- 

verses  the  Lobules. 

3.  Inter-Lobular  Tissue. 

4.  Parenchyma  of  the  Lobules. 

The  nerves  of  the  Liver  will  be  mentioned  at  another 
place,  along  with  the  general  account  of  such  as  belong  to 
the  Abdomen. 

The  Gall-Bladder,  (Vesicula,  sive  Cistis  Fellea,)  is  a re- 
servoir for  the  bile,  and  is  fixed  on  the  inferior  surface 
of  the  great  lobe,  to  the  right  of  the  umbilical  fissure,  (from 
which  it  is  removed  by  the  lobulus  quarters,)  in  a broad 
shallow  fossa.  It  is  not  placed  in  the  line  of  the  short 
diameter  of  the  liver,  but  somewhat  obliquely,  its  anterior 
end,  which  reaches  to  the  edge  of  the  liver,  being  turned 
to  the  right,  and  its  posterior,  which  goes  to  the  transverse 
fissure,  being  turned  towards  the  left.  Its  shape  is  that  of 
an  oblong  pyriform  sac,  the  base  being  rounded  off  and  the 
apex  curved;  the  body  diminishes  gradually  to  the  apex. 
The  gall-bladder  has  three  coats,  a peritoneal,  cellular  and 
mucous.  The  peritoneal  coat  is  only  a partial  one,  in  con- 
sequence of  the  upper  face  of  the  gall-bladder  being  in  con- 
tact with  the  liver.  The  second  coat  is  cellular  membrane, 
in  which  ramifies  a great  number  of  blood-vessels  and  lym- 


CONTENTS  OF  THE  ABDOMEN. 


219 


phatics.  The  third  is  always  tinged  of  a deep  green,  or 
yellow  colour  by  the  bile  after  death,  though  during  life  it 
is  pale.  On  its  internal  face,  it  is  thrown  into  irregular  tor- 
tuous folds  or  wrinkles  of  extreme  delicacy,  in  the  intervals 
of  which  are  many  round  or  polyhedrous  cells;  some  small, 
others  a line  and  a half  deep,  particularly  about  the  middle 
of  the  body.  In  the  neck  or  apex  of  the  gall-bladder  and 
in  the  beginning  of  the  cystic  duct,  from  three  to  seven  or 
more  elevated  semilunar  folds,  are  formed  of  the  internal 
membrane : which  sometimes  adopt  a spiral  arrangement, 
like  a valve. 

The  contiguous  parts  to  the  gall-bladder,  like  its  inner 
coat,  are  always  tinged  with,  bile  after  death,  which  does 
not  occur  in  the  living  body.  I have,  however,  in  one 
case  in  our  dissecting  rooms,  seen  a gall-bladder  in  an  old 
African  woman,  filled  by  a pint  of  very  fluid,  watery,  green- 
ish bile,  and  the  tissue  of  which  had  been  so  lax,  that  a 
quart  or  more  of  the  same  secretion  had  percolated  into  the 
abdomen,  probably  before  death. 

The  Hepatic  Duct  arises  as  stated,  by  very  delicate 
branches,  from  the  Acini  of  the  Liver.  These  branches 
are  united  into  three  or  four  trunks,  in  the  transverse  fis- 
sure, which  trunks,  again  unite  into  a single  one,  the  He- 
patic Duct,  about  the  size  of  a writing-quill,  and  eighteen 
or  twenty  lines  long.  The  Hepatic  Duct,  joins  at  a very 
acute  angle,  with  the  Cystic  Duct,  which  is  somewhat 
smaller  and  shorter,  and  the  two  form  the  Ductus  Commu- 
nis Choledochus.  The  biliary  canals  thus  formed,  are  si- 
tuated in  the  right  side  of  the  Hepatico-Gastric,  or  lesser 
Omentum,  in  what  is  commonly  called  the  Capsule  of  Glis- 
son.  The  Ductus  Communis  being  three  inches,  or  three 
and  a half  long,  is  to  the  right  of  the  Vena  Portarum,  and 
the  Hepatic  artery ; descends  behind  the  pancreas  and  the 
upper  part  of  the  duodenum,  and  passes  obliquely  between 
the  coats  of  this  intestine,  for  the  distance  of  an  inch,  its 
orifice  being  as  mentioned,  at  the  back  of  the  second  turn 
of  the  intestine.  The  Ductus  Communis,  sometimes  re- 
ceives the  Pancreatic  duct. 

The  Biliary  ducts  have  two  coats.  The  external  is  a 
lamellated  fibrous  membrane,  highly  extensible,  and  having 


220 


OF  THE  TRUNK. 


many  blood-vessels.  The  internal  is  of  the  same  character 
with  that  of  the  gall-bladder. 

OF  THE  SPLEEN  (LIEN,  SPLEN.) 

This  organ,  as  mentioned,  is  situated  deeply  in  the  left 
hypochondriac  region,  in  the  concavity  of  the  Diaphragm 
at  the  left  extremity  of  the  stomach,  and  above  the  Colon. 
Its  form  approaches  to  the  longitudinal  section  of  an  oval, 
being  commonly  four  and  a-half  inches  long,  and  two  and 
a-half  or  three  wide.  But  there  is  no  viscus  in  which  more 
frequent  varieties  of  magnitude  occur.  1 have  seen  it  ex- 
tending almost  to  the  Ilium,  and  but  little  smaller  than  the 
liver;  and  again,  not  by  any  means  the  length  just  men- 
tioned as  a medium  size.  Its  transitions  of  magnitude 
are  frequent  and  rapid  in  the  same  individual,  depending 
on  the  stage  of  digestion,  upon  sickness,  and  probably  on 
mental  sensations.  Several  spleens  sometimes  exist  in  the 
same  person.  In  such  cases  the  supernumerary  ones,  are 
for  the  most  part  very  small. 

The  Spleen  has  a partial  division  lengthwise,  by  a fossa, 
where  the  blood-vessels  are  connected  with  it.  Its  cir- 
cumference is  sometimes  notched.  Its  colour  varies  from 
a deep  blue,  which  it  is  in  early  life,  to  a very  dark  brown. 
It  is  fixed  by  three  processes  of  peritoneum,  the  names  of 
which  indicate  their  attachments;  the  Gastro-Splenic  liga- 
ment or  Omentum,  the  Splenico-Phrenic,  and  the  Splenico- 
Colic  Ligaments. 

The  external  coat  of  the  spleen  is  obtained  from  the  pe- 
ritoneum, being  a continuation  of  the  processes  just  men- 
tioned. The  internal  coat  is  a grayish,  compact,  extensible, 
elastic  membrane,  in  close  adherence  with  the  external ; it 
sends  in  processes  to  accompany  the  blood-vessels  ; and 
moreover  from  its  internal  face,  there  proceeds  a multitude 
of  lamellae  and  of  fibres,  dividing  its  cavity  into  cells.  It 
seems  to  be  intended  to  sustain  the  natural  shape  of  the 
spleen,  and  to  support  its  peculiar  structure. 

The  spleen  is  remarkably  well  furnished  with  blood-ves- 
sels. The  largest  branch  from  the  cosliac  artery,  runs  to  it 
along  the  superior  margin  of  the  pancreas  and  is  distin- 
guished by  its  tortuous  course,  and  by  the  branches  which 


CONTENTS  OF  THE  ABDOMEN. 


221 


it  furnishes  to  the  stomach  and  pancreas.  It  divides  into 
several  trunks  just  before  it  enters  the  spleen.  The  veins 
come  out  by  an  equal  number  of  trunks,  unite  into  one 
trunk,  and  attend  the  artery  along  the  upper  edge  of  the 
pancreas;  it  joins  the  Vena  Portarum.  The  splenic  vein 
is  destitute  of  valves. 

In  the  body  of  the  spleen,  are  found  many  grayish,  soft, 
semi-transparent,  gelatinous  corpuscles,  from  an  almost  im- 
perceptible magnitude  to  a line  or  more  in  diameter.  By 
Malpighi,  they  are  considered  glandular;  and  by  Ruysch, 
as  convoluted  vessels.  The  mass  of  the  spleen,  upon  a 
superficial  examination,  seems  to  consist  in  a bloody  dark 
brown  pulp,  contained  in  the  numerous  cells  of  the  internal 
coat.  On  this  cellular  structure,  the  vessels  pass.  M.  As- 
solont  considers  that  blood,  besides  existing  in  the  arteries 
and  veins,  is  placed  in  a state  of  particular  combination, 
and  of  intimate  union  with  the  other  organic  elements  of 
the  viscus,  and  with  a large  quantity  of  albumen  ; that  this 
peculiar  combination  of  the  blood  forms  the  dark  grumous 
fluid  just  mentioned,  which  may  be  easily  seen  by  scraping 
the  spleen  with  the  handle  of  a scalpel.  Of  the  latter,  there 
can  he  no  doubt;  but  a question  arises  whether  it  is  con- 
tained in  the  cells  I have  just  spoken  of,  or  in  the  extremi- 
ties of  the  vessels.  Slight  examination  is  in  favour  of  the 
former,  but  M.  Marjolin,  denies  it,  on  the  following  grounds. 
That  injections,  cautiously  made,  pass  immediately  from 
the  arteries  into  the  veins:  and  that  when  the  spleen,  suc- 
cessively injected,  is  frozen,  one  can  see  no  ice  in  the  in- 
terstices of  the  vessels,  while  the  capillary  ramifications 
of  the  vessels  distended  by  the  injected  fluid,  are  dis- 
tinctly seen.  The  probability  then  is,  that  the  peculiar 
structure  of  the  spleen,  is  formed  essentially  of  arterial  and 
venous  capillary  vessels,  with  very  delicate  and  extensi- 
ble coats,  that  they  communicate  with  each  other,  with- 
out the  intermedium  of  any  cell,  and  that  the  extreme 
tenuity  of  these  vessels,  and  their  extensibility  in  every  di- 
rection, are  sufficient  to  explain  the  augmentation  of  volume 
which  the  spleen  affords,  under  certain  circumstances,  and 
the  promptitude  with  which  it  diminishes  under  others. 

It  has  no  duct,  and  is  not  known  to  secrete  any  thing. 
Its  probable  function  is,  to  act  as  a diverticulum  of  blood 
from  the  liver. 


222 


OF  THE  TRUNK. 


OF  THE  PANCREAS,  (PANCREAS.) 

The  Pancreas  secretes  saliva,  and  is  the  largest  of  the 
salivary  glands.  It  is  an  oblong  conglomerate  gland,  ex- 
tending across  the  spine,  and  fixed  in  the  back  and  lower 
part  of  the  epigastric  region.  It  is  connected  to  the  spleen 
on  the  left,  to  the  duodenum  on  the  right,  is  behind  the 
stomach,  and  between  the  laminae  of  the  transverse  meso- 
colon. 

The  Pancreas  is  of  a light  gray  colour.  It  is  about  six 
or  seven  inches  long  and  two  wide  ; and  would  represent 
tolerably  a parallellogram,  if  at  its  right  extremity,  it  were 
not  swollen  out  into  a head,  to  which  Winslow  gave  the 
name  of  Lesser  Pancreas.  It  has  two  faces,  two  edges,  and 
two  extremities.  The  anterior  face  is  turned  obliquely  up- 
wards,  and  corresponds  with  the  superior  lamina  of  the  me- 
socolon. The  posterior  fa.ce  is  obliquely  downwards,  has 
a long  fossa  in  its  upper  part  for  the  splenic  vessels,  and  is 
in  contact  with  the  aorta,  vena  cava  ascendens,  the  supe- 
rior mesenteric  vessels,  and  several  nerves. 

The  pancreas  has  no  peritoneal  coat,  excepting  the  me- 
socolon, neither  has  it  a proper  tunic,  unless  we  should 
consider  as  such,  the  lamina  of  condensed  cellular  mem- 
brane which  envelopes  it,  and  which  sends  in  processes 
between  its  lobules. 

The  structure  of  the  pancreas,  strongly  resembles  that  of 
the  salivary  glands  and  consists  of  granuli,  united  into 
lobules,  which  form  lobes,  whose  interstices  are  occupied 
with  numerous  vessels.  The  excretory  duct  of  the  gland, 
arises  from  these  granulations  by  very  fine  radicles,  which, 
uniting,  form  larger  cylinders  inclining  from  left  to  right. 
These  latter  empty  successively  into  a long  tube,  the  Ductus 
Wirsungii,  going  the  whole  length  of  the  gland  and  situated 
near  the  very  centre  of  its  substance  ; it  is  small  at  the 
splenic  extremity,  but  gradually  increases,  till  it  becomes 
as  large  as  a crow’s  quill  at  the  other  end.  It  is  there 
joined  by  the  duct  of  the  lesser  pancreas,  and  in  a short 
course  afterwards,  empties  into  the  ductus  communis  cho- 
ledochus,  or  runs  at  its  side  and  makes  a distinct  opening 
into  the  duodenum.,  at  the  posterior  part  of  its  second  curva- 
ture. 


CONTENTS  OF  THE  ABDOMEN. 


223 


The  arteries  of  the  pancreas,  are  principally  derived  from 
the  splenic.  The  veins,  empty  into  the  splenic  vein. 

OF  THE  KIDNEYS,  (RENES.) 

To  get  a good  view  of  the  kidneys,  the  other  abdominal 
viscera  should  be  removed,  or  at  least  the  intestines. 

The  Kidneys  are  two  glandular  bodies  for  the  secretion 
of  urine,  fixed  one  on  each  side  of  the  spine.  They  are 
in  the  back  part  of  the  lumbar  regions,  in  a space  extending 
from  the  upper  part  of  the  eleventh  dorsal  vertebra  to  the 
lower  part  of  the  second  lumbar,  though  the  right,  in  con- 
sequence of  the  pressure  of  the  liver  from  above,  is  lower 
down  than  the  left.  They  are  deposited  in  a large  parcel 
of  fat  on  the  upper  part  of  the  great  psoae,  and  quadrati 
lumborum  muscles,  as  well  as  on  the  lower  part  of  the  great 
diaphragm. 

The  shape  of  the  kidney,  is  a compressed  ovoid,  exca- 
vated on  one  side  like  a kidney  bean.  The  broad  end  of 
the  ovoid  is  above,  and  the  excavation  presents  obliquely 
forwards  and  inwards.  The  latter,  has  a deep  fissure  in  it 
for  the  passage  of  the  blood-vessels  and  excretory  duct. 
The  kidney  is  hard  and  solid;  its  colour  is  brown. 

The  kidney  has  not  a peritoneal  coat,  but  it  has  a proper 
capsule,  which  completely  envelopes  it  and  penetrates  into 
its  fissure.  The  capsule  is  there  perforated  with  many 
foramina  for  transmitting  the  blood-vessels.  This  mem- 
brane is  fibrous,  semi-transparent,  and  somewhat  elastic  ; 
it  is  easily  peeled  from  the  surface  of  the  kidney,  and  in 
doing  so,  we  see  that  it  adheres  by  a very  delicate  cellular 
and  fibrous  tissue  and  by  some  small  vessels.  The  kidney 
being  originally  formed  in  lobes  which  subsequently  unite, 
the  vestige  of  this  union  is  frequently  preserved. 

The  kidney  being  laid  open  longitudinally,  we  shall  ob- 
tain an  idea  of  its  internal  arrangement.  It  is  seen  obvi- 
ously to  consist  of  two  parts  of  different  appearance;  the 
external,  which,  from  its  position,  is  called  Cortical ; and 
the  internal  Tubular. 

In  regard  to  the  structure  of  the  kidney,  it  receives  from 


224 


OF  THE  TRUNK. 


the  aorta,  at  right  angles,  a large  artery,  the  Emulgent, 
which  divides  into  several  branches  as  it  approaches  the 
fissure;  these  terminate  by  penetrating  to  all  parts  of  the 
gland  in  a crowd  of  arterioles,  so  that  when  they  are  in- 
jected with  wax  and  corroded,  the  figure  of  the  gland  is 
preserved.  Some  of  these  minute  arterial  branches  ter- 
minate in  corresponding  veins,  and  others  in  the  glandular 
structure  of  the  organ. 

The  Cortical  part  is  the  most  vascular ; it  is  on  an  ave- 
rage, about  two  lines  in  depth,  is  made  of  granules  called 
acini,  and  forms  the  periphery  of  the  gland ; but  different 
portions  of  it  project  and  form  partial  partitions  between 
the  tubular  sections.  It  tears  with  facility,  with  a granu- 
lated edge  or  surface,  and  its  colour  is  a dark  or  reddish 
brown.  When  viewed  with  a microscope,  the  granulations 
are  distinctly  seen  of  extreme  minuteness,  and  receiving 
the  capillary  extremities  of  the  arteries.  I have  more  than 
once  injected  these  granulations  from  the  arteries,  and  ob- 
served the  fluid  coming  through  the  ureter  and  the  emul- 
gent vein. 

The  second  or  Tubular  portion  of  the  kidneys,  to  the 
naked  eye,  consists  of  conoidal  fasciculi  of  fibres,  present- 
ing their  bases  to  the  periphery  of  the  organ,  and  their 
apices  towards  its  centre.  These  cones  are  from  twelve  to 
eighteen  in  number,  (Pyramides  Malpighianae,)  and  as  men- 
tioned, are  partially  separated,  from  each  other  by  processes 
from  the  cortical  part;  they  are  dense,  of  a lighter  brown, 
and  tear  with  facility  in  the  course  of  the  fibres.  Each 
cone  is  formed  by  a great  number  of  very  fine  canals,  con- 
verging close  to  each  other  near  the  apex,  and  joining. 
They  appear  only  to  give  passage  to  the  urine,  as  cases 
have  occurred,  in  which  they  were  entirely  removed  by 
suppuration  and  ulceration.  The  technical  name  for  these 
canals,  is  Tubuli  Uriniferi ; they  begin  in  the  cortical  part 
of  the  kidney  from  the  acini  and  pass  through  it  in  a ser- 
pentine course.  The  terminations  of  the  cones  are  called 
Papillse,  and  an  attempt  has  been  made  to  establish  for  them 
some  peculiarity  of  organization  ; but  that  idea  is  now 
abandoned,  and  they  are  generally  admitted  to  be  the  same 
with  the  other  portions  of  the  tubular  part.  Thev  have 
many  orifices  in  them,  which  are  the  terminations  of  the 


CONTENTS  OF  THE  ABDOMEN. 


225 


tubes,  and  from  which  urine,  in  most  subjects,  can  be  rea- 
dily squeezed. 

Fig.  47. 

A Vertical  Section  of  the  Left 
Kidney. 

1.  Cortical  or  Vascular  Structure. 

2.  Pyramids  of  Malpighi  or  Tubular 

Structure. 

3.  Papillae  or  Apices  of  Pyramids. 

4.  Terminations  of  other  Papillae  in  In- 

fundibula. 

5.  Calices. 

6.  The  three  Infundibula. 

7.  Pelvis  of  the  Ureter. 

8.  The  Ureter. 


OF  THE  EXCRETORY  DUCT  OF  THE  KIDNEY,  OR 
THE  URETER. 

The  Ureter  is  a canal  which  conveys  the  urine  from  the 
kidney  to  the  bladder.  It  begins  in  its  centre  by  a dilata- 
tion called  Pelvis,  and  branches  into  several  divisions  called 
Calices,  each  of  which  ends  in  three  or  more  funnel-shaped 
tubes,  named  Infundibula.  Each  of  these  embraces  by  its 
expanded  orifice,  the  base  of  the  papilla,  so  as  to  permit 
the  latter  to  project  into  it  and  distil  its  urine  there;  but 
sometimes,  there  are  two  papillse  to  one  infundibulum. 

The  Pelvis  of  the  kidney  is  continued  into  the  Ureter,  a 
canal  about  the  size  of  a writing  quill,  and  which  is  in  con- 
tact behind,  with  the  psoas  magnus  muscle  and  the  iliac  and 
hypogastric  vessels,  crosses  the  vas  deferens  at  the  back 
part  of  the  bladder,  and  passes  obliquely  through  the  coats 
of  the  latter,  to  end  in  an  orifice  a little  behind  that  of  the 
Urethra. 

The  excretory  duct  of  the  kidney  has  two  coats,  the  ex- 
ternal of  which  is  fibrous  and  the  internal  mucous.  The 
latter  is  said  to  be  continued  over  the  papillse,  and  also, 
by  some  anatomists,  to  enter  into  the  tubuli  uriniferi.  Its 

15 


226 


OF  THE  TRUNK. 


lower  end  is  continuous  with  the  internal  coat  of  the  blad- 
der. The  Ureter  enjoys  a great  degree  of  extensibility  and 
contractility  of  tissue,  as  shown  in  the  transmission  of  large 
calculi,  and  its  sensibility  not  perceptible  in  health,  is  ex- 
quisite in  disease. 

The  emulgent  veins  are  parallel  with  the  arteries,  and  ter- 
minate in  the  vena  cava  ascendens. 


OF  THE  RENAL  CAPSULES,  (CAPSULE  REXALES.) 

These  are  two  little  triangular  pyramidal  bodies,  one  for 
each  kidney,  and  rest  by  a concave  base  on  its  superior  part ; 
they  are  of  a yellowish  brown  colour,  somewhat  tinged  with 
red,  have  no  excretory  duct,  and  being  connected  with 
some  process  of  foetal  existence,  are  much  larger  then,  than 
in  the  adult ; their  structure  also  seems  to  be  much  changed 
in  the  latter.  They  are  about  fifteen  lines  high,  and  as  many 
wide. 

On  the  exterior  of  their  body  is  a proper  coat  formed  of 
lamellated  and  condensed  cellular  tissue,  which  furnishes 
from  its  internal  surface  many  prolongations,  dividing  the 
gland  into  lobes.  These  lobes  are  divisible  into  lobules, 
which  again  consist  of  a granulated  structure  that  seems 
susceptible  of  other  divisions.  These  granulations  are  not 
firm  and  resisting. 

In  the  centre  of  theCapsula  Renalis,  there  is  occasionally 
a triangular  cavity,  which  maybe  demonstrated  by  thrusting 
a tube  into  it,  and  inflating,  or  by  an  incision.  In  the  foetus 
this  cavity  contains  a reddish  viscid  fluid  eoagulable  by  al- 
cohol : in  children  it  becomes  yellow : in  adults  it  is  dark- 
brown,  and  in  old  people  it  is  either  wanting,  or  in  a remark- 
ably small  quantity. 

The  arteries  of  these  bodies  come  from  the  emulgents, 
the  phrenics  and  the  aorta.  The  veins  terminate  on  the 
right  side  in  the  cava*  and  on  the  left*  in  the  emulgent  vein. 


DIAPHRAGM. 


227 


SECTION  V. 

The  Diaphragm,  ( Diaphragma ,) 

Is  a complete,  though  moveable  septum,  placed  between 
the  thoracic  and  the  abdominal  cavity ; it  is  extremely  con- 
cave below,  and  convex  above,  the  concavity  being  occu- 
pied by  several  of  the  abdominal  viscera.  To  view  it  pro- 
perly, all  the  abdominal  viscera  should  be  removed,  a large 
billet  of  wood  placed  under  the  loins  of  the  subject,  and  the 
peritoneum  carefully  dissected  off.  It  is  particularly  ne- 
cessary to  attend  to  the  latter  direction  in  order  to  get  a 
good  view  of  the  varied  structure  of  this  important  organ, 
and  the  dissector,  while  performing  it,  is  continually  liable 
to  the  accident  of  a puncture  being  made  through  it  into 
the  thorax  ; in  which  case  the  diaphragm  loses  its  concavity, 
and  becoming  flabby  and  displaced,  the  value  and  beauty 
of  the  display  are  much  impaired. 

The  dissection  being  properly  achieved,  exhibits  a broad 
concave  muscle,  connected  with  the  inferior  margin  of  the 
thorax  on  all  sides,  and  having  for  its  centre  a silvery  ten- 
don resembling  in  its  outline  the  heart  of  a playing  card. 
This  cordiform  tendon,  occupies  a considerable  part  of  the 
extent  of  the  diaphragm,  has  its  apex  next  to  the  sternum, 
and  its  notch  towards  the  spine  ; the  muscular  part  of  the 
diaphragm  is  inserted  all  around  into  its  circumference. 
The  cordiform  tendon  is  nearly  horizontal  in  the  erect  pos- 
ture, its  elevation  being  on  a line  with  the  lowest  end  of  the 
second  bone  of  the  sternum.  On  each  side  of  this  tendon, 
some  of  the  muscular  fibres  rise  so  high  upwards  before 
they  join  it,  that  they  are  on  a horizontal  level  with  the  an- 
terior end  of  the  fourth  rib.  The  fasciculi  of  muscular 
fibres,  are  for  the  most  part,  convergent  from  the  circum- 
ference of  the  thorax,  and  are  easily  separated  from  each 
other. 

In  the  diaphragm  are  three  remarkable  foramina.  The 
first,  ( Foramen  (Esophageum ) is  in  the  back  of  the  muscle 
between  the  spine  and  the  notch  of  the  cordiform  tendon, 
a little  to  the  left  of  the  middle  line.  It  gives  passage  to 


228 


OF  THE  THUNK. 


the  (Esophagus  and  the  Par  Vagum  nerves  along  -with  it, 
and  is  rather  a fissure  or  a long  elliptical  foramen  made  by 
the  separation  and  reunion  of  the  muscular  fibres;  for  above 
and  below  at  each  end  of  the  ellipsis  these  fibres  decussate 
each  other  in  columns.  To  the  right  of  this  foramen  and 
a little  above  its  horizontal  level,  in  the  back  part  of  the 
eordiform  tendon,  is  a very  large  and  patulous  foramen, 
(. Foramen  Quadratum ) for  the  Ascending  Vena  Cava.  Its 
form  is  between  an  irregular  quadrilateral  ligure  and  a cir- 
cle; its  edges  are  composed  of  fasciculi  of  tendon  rounded 
off,  and  are  not  susceptible  of  displacement,  or  of  alteration 
in  their  relative  position  to  each  other,  by  which  means  any 
impediment  which  might  arise  from  a different  arrangement, 
to  the  course  of  the  blood  in  the  ascending  cava,  is  obviated. 
Almost  in  a vertical  line  below,  and  about  three  inches 
from  the  foramen  for  the  oesophagus,  is  the  third  hole 
in  the  diaphragm  ( Hiatus  Aorticus)  which  affords  passage  to 
the  Aorta.  It  is  just  in  front  of  the  bodies  of  the  three  up- 
per lumbar  vertebrae,  and  is  a much  longer  elliptical  hole 
than  the  oesophageal;  its  lowest  extremity  or  pole  is  con- 
stituted by  the  tendinous  crura  of  the  diaphragm,  and  its 
upper  by  a decussation  of  muscular  fasciculi  arising  from 
them.  Through  it,  besides  the  Aorta,  pass  the  Thoracic 
Duct,  and  the  Great  Splanchnic  Nerve  of  both  sides. 

In  the  horizontal  position  of  either  the  dead  or  the  living 
body,  the  right  side  of  the  diaphragm  ascends  higher  in  the 
thorax  than  the  left,  but  the  wreight  of  the  liver  makes 
it,  in  the  vertical  posture,  descend  lower  than  the  other. 

Thus  circumstanced,  the  detailed  origin  of  the  Diaphragm 
is  as  follows.  Itarises  fleshy,  from  the  internal  face  of  the  upper 
edge  of  the  Xiphoid  Cartilage,  from  the  internal  face  of  the 
cartilages  of  the  seventh,  eighth,  and  ninth  ribs,  from  the  os- 
seous extremities  of  the  tenth  and  eleventh,  and  from  both 
the  osseous  and  cartilaginous  termination  of  the  twelfth  rib. 
Asthe  line  described,  includes  almostthe  whole  of  the  circle, 
and  the  fibres  all  converge  to  the  eordiform  tendon,  they, 
of  course  will  pass  in  different  radiated  directions,  and  be 
of  different  lengths,  which  it  is  unnecessary  to  specify.  Be- 
tween the  sternal  and  costal  portions,  on  each  side,  there 
is  a triangular  fissure  filled  with  fatty  cellular  tissue,  which 
sometimes  leaves  an  opening  for  Hernia.  I have  seen  a 
case  of  this  kind,  in  which  the  transverse  part  of  the  Colon 


DIAPHRAGM. 


229 


was  the  subject  of  protrusion  into  the  Thorax.  It  is  pro- 
bable that  greater  displacements  of  the  abdominal  viscera, 
into  the  thorax  of  adults  or  children,  may  have  had  a con- 
genital origin  in  this  very  fissure,  and  are  subsequently, 
when  the  parts  are  modified  to  this  unnatural  situation,  set 
down  as  a Lusus  Naturae.  The  portion  just  described,  is 
called  the  Greater  Muscle  of  the  Diaphragm. 

Besides  these  origins,  the  Diaphragm  has  several  from 
the  vertebrae  of  the  loins,  called  its  crura,  there  being  four, 
on  each  side  of  the  foramen  for  the  aorta.  The  first 
pair,  entirely  tendinous,  comes  from  the  front  of  the  body 
of  the  third  vertebra  of  the  loins,  and  is  prevented  from 
being  very  distinct  in  its  origin,  in  consequence  of  running 
into  the  ligament  in  front  of  the  bodies  of  all  the  vertebrae. 
The  second  pair  of  heads  is  on  the  outside  of  the  first,  and 
arises  tendinous,  from  the  intervertebral  ligament,  between 
the  second  and  third  vertebrae.  The  third  pair  of  heads 
arises  tendinous,  from  the  upper  part  of  the  lateral  margins 
of  the  second  lumbar  vertebra.  And  the  fourth  pair  of 
heads,  comes  also  tendinous  from  the  fore  part  of  the  roots 
of  the  transverse  processes  of  the  second  lumbar  vertebra. 
These  tendinous  heads  terminate  in  what  is  called  the 
Lesser  Muscle  of  the  Diaphragm,  which  is  inserted  into 
the  notch  of  the  cordiform  tendon.  It  will  now  be  un- 
derstood that  the  aorta  passes  between  the  heads  of  the 
lesser  muscle,  and  that  the  oesophagus  has  a hole  in  the 
upper  part  of  its  belly.* 

The  origin  of  the  Diaphragm  is  completed  between  its 
greater  and  lesser  muscles,  by  a tense  ligament,  called  the 
Ligamentum  Arcuatum,  which  passes  from  the  root  of  the 
transverse  process  of  the  first  lumbar  vertebra,  to  the  infe- 
rior part  of  the  middle  of  the  twelfth  rib ; with  the  upper 
edge  of  this  ligament  the  Diaphragm  is  connected  ; and 
with  the  lower,  the  psoas  rnagnus  muscle.  At  the  margin 
of  the  other  ribs,  the  diaphragm  is  connected  with  the 
transversalis  abdominis. 

The  action  of  this  muscle,  in  assisting  respiration,  is 

* This  origin  of  the  lesser  muscle  of  the  Diaphragm  is  given  by 
Albums,  but  it  is  difficult  to  make  out  fairly,  and  for  the  most  part  it 
would  do  much  better  to  say,  that  it  arises  tendinous,  from  the  first, 
second,  and  third  vertebrae.  The  heads  are  occasionally  much  smaller 
on  one  side  than  the  other. 


230 


OF  THE  TRUNK. 


very  obvious  ; its  fibres  passing  in  a curved  line  with  their 
convexity  towards  the  thorax,  from  the  bony  margin  of  the 
thorax  to  the  cordiform  tendon,  and  having  a tendency  to 
become  straight  by  contracting,  will  descend,  and  thereby 
enlarge  the  thorax.  It  is  not  certain  that  the  cordiform 
tendon  descends,  its  connexions  being  too  strong  and  nu- 
merous to  admit  of  much  motion.  In  expiration,  the  re- 
laxation of  the  Diaphragm,  with  the  contraction  of  the  ab- 
dominal muscles,  restores  the  former  to  its  first  state.  In 
vomiting,  the  Diaphragm  and  abdominal  muscles  concur  to 
expel  the  contents  of  the  stomach. 

The  Psoas  Magnus  muscle,  arises  fleshy,  from  the  side 
of  the  bodies  of  the  last  dorsal,  and  of  the  four  upper  lum- 
bar vertebrae,  and  from  the  transverse  processes  of  all  the 
lumbar  vertebrae.  It  forms  an  oblong  fleshy  cushion  on  the 
side  of  the  lumbar  vertebrae,  and  constituting  the  lateral 
boundary  of  the  inlet  to  the  pelvis,  it  passes  out  of  the  pel- 
vis, under  Poupart’s  ligament  about  its  middle. 

It  is  inserted,  tendinously,  into  the  trochanter  minor  of 
the  os  femoris,  and  fleshy  for  an  inch  below  it. 

It  bends  the  body  forwards,  or  draws  the  thigh  up- 
wards. 

The  Psoas  Parvus,  arises  fleshy,  from  the  contiguous 
edges  of  the  last  dorsal,  and  of  the  first  lumbar  vertebra  at 
their  sides,  and  from  the  intervertebral  ligament.  It  is  at 
the  anterior  and  internal  edge  of  the  psoas  magnus ; has  a 
short  belly,  and  a long  tendon,  by  which  it  is  inserted  into 
the  linea  innominata,  about  half-way  between  the  spine  of 
the  pubes,  and  the  junction  of  this  bone  with  the  ilium. 
The  tendon,  besides,  is  expanded  into  the  fascia  iliaca. 

Its  use  seems  to  be,  to  draw  upwards  the  sheath  of  the 
femoral  vessels  which  is  derived  from  the  fascia  iliaca,  and 
consequently  to  draw  upwards  the  vessels  themselves, 
which  probably  diminishes  the  liability  to  injury  from 
their  too  great  or  sudden  flexion.  This  muscle  is  some- 
times wanting. 

The  Iliacus  Internus,  occupies  the  concavity  of  the 
ilium,  being  on  the  outside  of  the  psoas  magnus.  It  arises, 
fleshy,  from  the  transverse  process  of  the  last  lumbar  ver- 


QUADRATUS  LUMBORUM. 


231 


tebra,  from  the  inner  margin  of  the  crista  of  the  ilium,  and 
from  its  whole  concavity;  also  from  the  anterior  edge  of 
the  concavity  of  the  ilium  at  and  above  the  anterior  inferior 
spinous  process,  and  from  that  part  of  the  capsule  of  the 
hip  joint  near  this  process. 

This  muscle  terminates  in  the  tendon  of  the  psoas  mag- 
nus,  just  above  the  insertion  into  the  trochanter  minor. 

It  has  the  same  action  with  the  psoas  magnus,  and  from 
their  also  having  a common  tendon,  they  might  with  pro* 
priety  be  considered  as  only  one  muscle. 

The  Quadratus  Lumborum,  is  an  oblong  muscle  arising 
from  the  crista  of  the  ilium,  by  a tendinous  and  fleshy 
origin  of  two  or  three  inches  in  length.  It  lies  at  the  side 
of  the  lumbar  vertebrae,  and  is  inserted  into  all  their 
transverse  processes  by  short  tendinous  slips.  It  is  also 
inserted  into  the  lower  edge  of  the  last  rib  near  its  head, 
and  into  the  transverse  process  of  the  last  vertebra  of  the 
back. 

It  bends  the  loins  to  one  side,  and  will  draw  down  the 
last  rib.  This  muscle  is  covered  posteriorly,  by  the  tendi- 
nous origin  of  the  transversalis  abdominis  muscle,  which 
separates  it  from  the  sacro-lumbalis  and  longissimus-dorsi. 
It  may  also  be  very  well  seen  from  behind,  in  the  dissection 
of  the  back. 


PART  II. 


CHAPTER  III. 

OF  THE  MALE  PELVIS. 

The  first  step  of  the  student,  after  a short  examination 
in  situ  of  the  contents  of  the  pelvis,  should  be  to  detach 
the  penis  from  its  bony  connexions,  and  to  remove  it,  with 
the  bladder  and  rectum,  from  the  pelvis.  Then  to  make  a 
fair  and  clean  dissection  of  these  organs  by  detaching  the 
surrounding  fat,  cellular  membrane  and  muscles.  This 
dissection  is  best  made  with  the  scissors,  and  its  utility  is 
in  proportion  to  its  cleanness  ; the  latter  is  much  assisted  by 
inflating  the  bladder  and  by  stuffing  the  rectum.  The  scro- 
tum may  be  separated  and  laid  aside  for  future  examination. 


SECTION  I. 

Of  the  Viscera  of  the  Male  Pelvis. 

The  Rectum,  being  the  termination  of  the  colon,  begins 
at  the  left  sacro-iliac  symphysis ; from  thence  it  passes  down 
obliquely  towards  the  middle  of  the  sacrum  about  one  half 


MALE  PELVIS. 


233 


of  its  length  ; its  course  afterwards  is  directly  downwards 
before  the  sacrum  and  os  coccygis,  till  it  terminates  in  the 
anus ; its  orifice  there  points  backwards  and  downwards. 
It  is  round  till  just  before  its  termination,  it  then  dilates  into 
a pouch  which  is  spread  on  each  side  of  the  prostate,  and 
is  apt  to  be  cut  in  lithotomy. 

The  inferior  third  of  the  rectum  is  destitute  of  perito- 
neum, its  anterior  face  is  in  contact  with  the  lower  fundus 
of  the  bladder,  the  vesiculae  seminales,  and  the  prostate 
gland.  Posteriorly  and  above,  it  is  confined  to  the  sacrum 
by  the  mesorectum,  which  conducts  its  nerves  and  blood- 
vessels. The  dip  of  the  peritoneum  between  the  vesiculae 
seminales  so  as  almost  to  touch  the  base  of  the  prostate 
gland,  should  be  remarked. 

The  muscular  structure  of  this  gut  is  remarkably  strong, 
consisting  externally,  of  longitudinal  and  parallel  fasciculi  of 
fibres,  close  together;  and  internally,  of  circular  fibres  which 
form  a thick  and  continued  plane,  particularly  on  a level 
with  the  lowrer  fundus  of  the  bladder.  Just  below  the 
pouch  of  the  rectum  these  circular  fibres  are  multiplied  so 
as  to  form  a perfect  Internal  Sphincter  Muscle.  Many  of 
the  longitudinal  fibres  on  getting  to  its  inferior  margin, 
pass  beneath  it,  and  are  then  turned  upwards  for  an  inch 
or  so,  so  as  to  be  inserted  into  the  mucous  coat,  or  rather 
its  cellular  substance.  The  mucous  membrane  of  the  gut 
is  smooth  above,  but  at  the  lower  part,  it  is  thrown  into 
several  longitudinal  folds  called  the  Columns  of  the  rectum, 
at  the  lower  end  of  which  are  some  small  blind  pouches  the 
orifices  of  which  look  upwards ; they  are  occasionally  the 
seat  of  disease,  and  produce  when  enlarged  a painful  itching. 
An  original  observation  of  Dr.  Physick,  on  the  nature  of 
this  affection,  and  the  remedy  for  which,  consists  in  slitting 
them  open  or  removing  them,  induced  me  to  look  for  the 
ordinary  natural  structure,  which  I have  found  to  be  as  just 
described.  The  Anus  is  thrown  into  radiated  folds  from 
the  influence  of  the  external  sphincter  ani.  In  some  sub- 
jects large  cells  are  formed  in  the  cavity  of  the  rectum,  by 
transverse  doublings  of  the  mucous  coat  only,  resembling 
the  valvulae  conniventes  of  the  small  intestine,  and  there 
is  also,  frequently  a sort  of  valve  formed,  which  presents  a 
barrier  to  the  involuntary  evacuation  of  the  faeces. 


234 


OF  THE  TRUNK. 


A Vertical  Section  of  the  Parietes  of  the  Ands,  with  the 
Rectum,  so  as  to  show  the  relation  of  the  Rectal  Pouches 
to  the  surrounding  Parts,  their  Orifices  being  marked  by 
Bristles. 

Fig.  48. 


1.1.  Columns  of  the  Rectum. 

2.2.  Rudiments  of  Columns. 

3.  Section  of  Internal  Sphincter. 

4.  Section  of  External  Sphincter. 

5.5.  Radiated  Folds  of  the  Skin  on  the  Surface  of  the  Nates. 

6.  Imperfect  Pouches. 

7.  Bristles  in  the  Rectal  Pouches. 


MALE  PELVIS. 


235 


The  Bladder  (Vesica  Urinaria,)  is  the  reservoir  for  the 
urine,  and  is  fixed  just  behind  the  symphysis  of  the  pubes, 
and  when  pressed  upon  by  the  neighbouring  viscera,  is 
somewhat  flattened  before  and  behind;  but  removed  from 
the  body  and  distended,  it  resembles  an  elongated  sphere, 
of  which  the  greatest  diameter  is  vertical  in  regard  to  the 
linea  ilio-pectinea.  The  technical  name  for  each  end  of  the 
sphere  is  Fundus,  distinguished  by  the  terms  superior  and 
inferior,  the  lower  being  somewhat  the  more  obtuse.  From 
the  upper  end  proceeds  to  the  navel  a long  conical  ligament, 
the  Urachus,  which  is  placed  between  the  linea  alba  and 
tlie  peritoneum,  and  produces  a slight  doubling  or  elevation 
of  the  latter.  In  mankind  the  urachus  is  solid,  but  some 
very  rare  cases  are  reported  in  which  it  was  so  hollow  as  to 
permit  the  urine  to  flow  through  it  from  the  bladder.  By 
putting  the  anterior  parietes  of  the  abdomen  on  the  stretch 
Ave  shall  see  starting  out  and  protruding  the  peritoneum  into 
a semilunar  duplicature  on  each  side  of  the  urachus,  the 
remains  of  the  umbilical  arteries  of  the  fcetus,  Avhich  now 
are  called  the  Round  Ligaments  of  the  Bladder,  though 
they  have  but  little  or  no  influence  on  it.  At  the  anterior 
part  of  the  lower  fundus,  the  bladder  is  somewhat  elon- 
gated into  a process  called  its  Neck,  resembling  a truncated 
cone,  and  being  the  commencement  of  the  urethra. 

The  bladder  consists  of  four  coats  ; the  Peritoneal,  Mus- 
cular, Cellular,  and  Mucous. 

The  Peritoneal  is  a very  incomplete  coat,  placed  upon 
the  upper  and  posterior  parts  of  the  bladder,  and  passing 
from  it  to  the  muscles  of  the  abdomen  before,  and  to  the 
rectum  behind.  It  is  connected  to  the  muscular  coat  by 
very  loose  cellular  membrane,  which  prevents  it  from  par- 
ticipating in  any  considerable  distentions  of  the  organ,  and 
permits  it  to  leave  the  anterior  face  of  the  bladder,  so  that 
its  reflection  to  the  recti  muscles  in  these  cases,  is  placed 
much  abo\Te  the  pubes.  Tapping  the  bladder  is  performed 
at  this  point,  as  well  as  the  high  operation  for  the  stone. 

The  Muscular  coat,  consists  of  flattened  fasciculi  of 
white  fibres  passing  in  very  varied  directions,  and  separated 
to  some  distance  from  each  other.  Many  of  them  arise 


236 


OF  THE  TRUNK. 


from  the  neck  of  the  bladder  and  pass  before  and  behind, 
upwards  towards  the  urachus,  where  they  end ; others, 
arising  laterally  from  the  same  place,  pass  up  in  a corre- 
sponding course  and  also  terminate  at  the  urachus.  There 
are  many  transverse  and  oblique  fibres  uniting  these  to- 
gether, but  still  leaving  interstices  through  which  the  in- 
ternal coat  occasionally  protrudes,  and  thus  forms  cells  in 
the  cavity  of  the  bladder.  There  is  an  accumulation  of 
fibres  about  the  neck  of  the  bladder  and  the  urachus,  which 
gives  an  increased  thickness  at  these  points. 

The  Cellular  coat,  consists  of  a close,  dense,  lamei- 
lated,  and  filamentous  tissue,  highly  extensible  and  difficult 
to  tear.  It  is  impervious  to  water,  closely  adherent  to  the 
muscular  and  mucous  membranes,  and  pervaded  by  many 
vessels  and  nerves  which  it  conveys  to  the  mucous  coat. 

The  Mucous,  or  internal  coat  of  the  bladder,  though 
called  villous,  has  less  of  this  appearance  than  that  of  the 
stomach.  It  is  white,  with  a slight  tinge  of  red;  abounds 
with  mucous  follicles,  which,  in  a state  of  health,  are  diffi- 
cult to  be  discerned ; possesses  great  extensibility  and  but 
little  contractility,  from  whence,  when  the  bladder  is  not 
very  full,  it  is  thrown  into  folds  passing  in  various  direc- 
tions. It  offers  several  points  for  observation.  1.  A tri- 
angular space  between  the  orifice  of  the  urethra  and  those 
of  the  ureters,  (the  Vesical  Triangle,)  which  is  elevated  into 
a plain  smooth  surface.  2.  The  Uvula  Vesicse,  a small 
pointed  production,  terminating  the  triangle  in  front,  and 
formed  by  a projection  of  the  third  lobe  of  the  prostate 
gland  into  the  cavity  of  the  bladder.  3.  The  orifices  of 
the  ureters,  about  an  inch  behind  the  orifice  of  the  urethra, 
and  forming  the  lateral  angles  of  the  vesical  triangle.  4. 
The  Inferior  F undus,  (Bas-F ond  of  the  F rench,)  a depression 
of  the  general  concavity  of  the  bladder,  making  it  lower 
than  any  other  part,  placed  between  the  base  of  the  triangle 
and  the  posterior  side  of  the  bladder.  5.  The  Internal 
Orifice  of  the  neck  of  the  bladder,  resembling  somewhat 
the  neck  of  a Florence  flask. 

The  Neck  of  the  Bladder  is  thicker  than  any  other  part ; 
it  is  surrounded  by  cellular  tissue,  in  which  a great  number 


MALE  PELVIS. 


237 


of  veins  is  found,  and  it  penetrates  in  front,  the  prostate 
gland,  which  has  a continual  tendency  to  close  it.  It  has  a 
sphincter  muscle  formed  in  the  following  way,  which  may 
be  seen  by  removing  the  lining  membrane.  A transverse 
fasciculus  crosses  its  inferior  semi-circumference  from  one 
lateral  lobe  of  the  prostate  gland  to  the  other ; this  fascicu- 
lus is  half  an  inch  wide  and  from  one  to  two  lines  thick, 
and  is  placed  over  the  third  lobe  of  the  prostate.  The  su- 
perior semi-circumference  is  also  crossed  by  a thin  layer  of 
muscular  fibres,  which  spreads  itself  out  at  the  ends  where 
it  is  lost  in  the  ordinary  muscular  structure  which  it  resem- 
bles exactly. 

Under  the  mucous  membrane  corresponding  with  the 
vesical  triangle,  there  is  a muscle  of  the  same  shape  and  di- 
mensions, the  posterior  corners  being  inserted  around  the 
orifices  of  the  ureters,  and  the  anterior  attached  to  the  caput 
gallinaginis. 


PROSTATE  GLAND,  (GLANDULA  PARASTATA.) 

This  is  a body  about  the  size  and  form  of  a horse  chest- 
nut, fixed  as  stated  on  the  neck  of  the  bladder,  and  pene- 
trated by  the  urethra,  which  traverses  it  much  nearer  its 
superior  than  its  inferior  surface.  The  base  of  it  is  turned 
backwards,  and  the  point  forwards  ; its  inferior  surface  rests 
upon  the  rectum,  and  its  sides,  in  the  distentions  of  this 
organ  by  faeces,  are  overlapped  by  it.  The  Prostate  has, 
posteriorly,  a notch  in  its  centre,  which  divides  it  into  two 
lateral  lobes,  and  by  raising  the  vesiculae  seminales,  wTe 
shall  see  where  their  excretory  ducts  penetrate  the  gland, 
and  separate  from  the  body  of  it  the  little  tubercle,  called 
the  Third  Lobe,  and  which  is  often  the  seat  of  disease. 

The  organization  of  this  body,  seems  to  consist  in  a con- 
densed, white,  extensible,  though  easily  lacerated  fibro-cel- 
lular  tissue,  and  within  it  are  placed  a great  number  of 
mucous  follicles,  which  form  from  eight  to  twelve  ducts,* 
passing  obliquely  forwards,  and  terminating  in  the  urethra 
at  the  sides  of  the  urethral  crest  or  Caput  Gallinaginis. 
The  fluid  secreted  is  thick,  ropy,  white,  and  semitransparent 


* Loder  says  there  are  from  thirty-two  to  forty-four. 


238 


OF  THE  TRUNK. 


in  a healthy  state.  The  Prostate  is  surrounded  by  a fibrous 
capsule,  of  which  more  hereafter.* 

Cowper’s  Glands  are  two  in  number,  and  are  situated 
in  advance  of  the  prostate,  between  the  laminae  of  the  tri- 
angular ligament,  at  the  point  where  the  bulb  of  the  urethra 
adheres  to  it.  These  glands  are  also  intended  for  the  secre- 
tion of  mucous,  or  a fluid  very  much  like  it,  into  the  canal 
of  the  urethra.  Commonly  they  are  about  the  size  of  a 
garden-pea,  but  not  unfrequently  much  smaller,  and  in  some 
instances  cannot  be  found  at  all.  They  are  yellowish  and 
hard  bodies,  consisting  of  several  lobules  united  together, 
and  each  one  has  an  excretory  duct,  that  readily  receives  a 
bristle,  which  passes  obliquely  forwards  between  the  corpus 
spongiosum  and  the  canal  of  the  urethra,  to  terminate  in  an 
oblique  orifice  in  the  latter,  about  an  inch  distant  from  the 
gland.  One  or  more  glands  of  the  same  description  and 
discovered  by  Littre,  are  occasionally  found  just  in  front  of 
Cowper’s.  They  also  discharge  their  secretion  into  the  ad- 
jacent part  of  the  urethra. 

The  Seminal  Vesicles,  (Vesiculse  Seminales,)  are  two 
convoluted  bodies  of  two  inches  in  length,  one  on  each 
side  of  the  lower  fundus  of  the  bladder,  approaching  each 
other  very  nearly  at  the  base  of  the  Prostate,  but  diverging 
much  as  they  recede.  They  are  separated  before,  by  the 
interposition  of  the  vasa  deferentia;  and  being  fixed  be- 
tween the  rectum  and  the  bladder,  they  are  matted  to  the 
latter  by  a close  cellular  texture,  having  many  large  veins 
pervading  it. 

When  inflated  and  dried,  they  present  the  semblance  of 
cells,  but  are  in  fact  long  tubes,  which,  by  being  convo- 
luted, are  reduced  to  the  apparent  dimensions  mentioned : 
there  are  also  several  pouches  on  each  side  of  this  long 
tube  which  increase  the  number  of  cells.  The  convolu- 
tions are  preserved  by  the  intermediate  cellular  tissue. 

* An  opinion  prevails  among-  the  anatomists  of  Philadelphia,  that 
the  prostate  is  larger  in  the  African  than  in  whites.  Indeed  this 
much  may  be  said  of  all  the  organs  of  generation  in  both  sexes. 


MALE  PELVIS. 


239 


A Side  View  of  the  Viscera  of  the  Pelvis,  showing  the  Blad- 
der AND  ITS  SURROUNDING  PARTS. 

Fig.  49. 


1.  Symphysis  Pubis. 

2.  The  Bladder. 

3.  The  Recto-Vesical  Fold  of  the  Peritoneum. 

4.  The  Ureter. 

5.  The  Vas  Deferens. 

6.  Vesicula  Seminalis  of  the  Right  Side. 

7.  Section  of  the  Prostate  Gland. 

8.  Section  of  the  Neck  of  the  Bladder. 

9.  Prostatic  Portion  of  Urethra. 

10.  Membranous  Portion. 

11.  Corpus  Spongiosum. 

12.  Anterior  Ligament  of  the  Bladder. 

13.  Rectal  End  of  the  Pelvic  Fascia. 

14.  Space  between  the  Deep  and  Pelvic  Fascia. 

15.  Triangular  Ligament. 

16.  One  of  Cowper’s  Glands. 

17.  Continuation  of  Superficial  Perineal  Fascia. 

18.  Scrotum. 

19.  Deep  Fascia  prolonged  to  the  Rectum. 

20.  Portion  of  the  Levator  Ani. 

21.22.  Course  of  Deep  Fascia. 

These  bodies  consist  of  two  coats,  an  external,  which  is 
fibrous  and  cellular,  and  an  internal,  which  is  mucous, 
being  a continuation  of  the  lining  membrane  of  the  blad- 
der. The  excretory  duct  of  each  vesicle  is  about  a line  and 
a-half  long,  when  it  joins  in  the  substance  of  the  prostate, 
with  the  vas  deferens  of  the  same  side ; a common  canal, 


240 


OF  THE  TRUNK. 


(Ductus  Ejaculatorius)  is  thus  formed,  which  runs  parallel 
with  its  fellow,  below  the  urethra.  They  are  commonly 
filled  by  a drab-coloured  thick  fluid,  supposed  to  be  a mix- 
ture of  the  semen  and  of  their  own  proper  secretion,  though, 
of  this,  Mr.  Hunter  doubted.* 

The  Ductus  Ejaculatorius,  is  about  eight  or  ten  lines 
long,  and  opens  by  an  oblong  orifice,  at  the  lateral  anterior 
face  of  the  Caput  Gallinaginis ; it  is  larger  behind  than  be- 
fore, which  gives  it  a conical  shape,  and  allows  fluids  in- 
jected, to  pass  freely  from  the  vas  deferens  to  the  vesicula, 
or  the  reverse. 


OF  THE  PENIS,  (MEMBRUM  VIRILE,  MENTULA.) 

The  Penis  is  a membranous  and  cellular  body,  affixed  to 
the  margin  of  the  pelvis  at  and  below  the  symphysis  pubis, 
and  appropriated  to  the  passing  of  urine  and  semen.  It  is 
formed  by  the  common  integuments,  by  cellular  tissue,  by 
the  corpus  cavernosum,  and  by  the  corpus  spongiosum. 

The  skin  covering  the  penis  is  more  thin  and  delicate 
than  in  most  other  parts  of  the  body,  and  is  furnished  with 
a considerable  number  of  sebaceous  follicles,  more  particu- 
larly about  the  root  of  the  organ.  It  is  very  loosely  con- 
nected by  cellular  membrane  to  the  parts  beneath,  so  that 
it  is  easily  made  to  correspond  with  all  states  of  the  penis. 
At  the  anterior  extremity  it  is  arranged  into  a duplicature  or 
fold,  the  Preputium,  which  is  inserted  just  behind  the  glans  ; 
the  inferior  part  of  the  prepuce  is  connected  with  the  ex- 
tremity of  the  glans  by  a process  called  Frsenum. 

The  penis,  besides  arising  from  the  bones  of  the  pelvis 
in  a manner  which  will  be  presently  explained,  is  fixed  to 
the  symphysis  pubis  by  a ligament,  (Ligamentum  Suspenso- 
rium,)  which  is  a triangular  fibrous  body,  flattened  laterally 
and  lost  insensibly  on  the  fascia  of  the  thigh  covering  the 
adductor  muscles.  The  portion  of  it  which  goes  to  the 
penis,  arises  in  front  of  the  symphysis  pubis,  and  is  inserted 
into  the  dorsum  of  the  penis  near  its  root ; from  this  in- 


* See  Observations  on  the  Animal  Economy. 


MALE  PELVIS. 


241 


sertion  it  is  extended  over  the  penis,  and  according  to  Mr. 
Codes,  constitutes  one  of  its  coverings,  by  going  as  far  as 
the  glans.  Professor  Marjolin  says  that  he  has  seen  on 
several  occasions,  muscular  fibres  entering  into  its  composi- 
tion, and  in  that  case,  it  draws  the  organ  with  more  force 
towards  the  anterior  parietes  of  the  abdomen,  and  one 
strongly  marked  instance  has  also  been  presented  to  me  in 
my  own  dissections. 

The  Corpus  Cavesnosum  of  the  penis,  forms  by  much 
the  most  considerable  portion  of  the  whole  organ.  Exter- 
nally, it  is  a white  fibrous  membrane  of  a dense  structure, 
enjoying  extensibility,  and  an  extreme  degree  of  contractility; 
its  fibres  pass  for  the  most  part  longitudinally,  except  about 
the  root,  where  they  are  blended  with  the  periosteum  of  the 
bone  and  with  the  tendons  of  the  muscles.  This  coat  of 
the  penis  is  occasionally  called  its  elastic  ligament.  It 
arises  by  two  conical  crura,  one,  from  the  internal  face  of 
the  crus  of  each  pubes  and  ischium,  to  within  a little  dis- 
tance of  the  anterior  part  of  the  tuber  ischii.  At  the  lower 
part  of  the  symphysis  pubis,  these  crura  join  and  form  a 
body,  which,  when  stripped  of  its  connexions,  resembles 
two  cylinders  lying  along  side  of  each  other  and  united  ; 
anteriorly  they  terminate  in  common  by  a truncated  cone, 
covered  obliquely  by  the  glans.  At  the  posterior  part  of 
the  corpus  cavernosum,  in  its  centre,  there  is  a tolerably 
complete  septum  of  the  same  kind  of  substance,  separating 
its  two  halves  from  each  other,  but  anteriorly  this  septum  is 
imperfect,  having  an  arrangement  like  the  teeth  of  a comb, 
whence  the  term,  Septum  Pectiniforme. 

In  the  middle  of  the  corpus  cavernosum  above,  is  a 
longitudinal  depression  for  lodging  the  veins  of  the  penis, 
and  in  the  same  manner  below,  another  for  the  corpus 
spongiosum  urethras.  The  cavity  of  this  membrane  is 
filled  by  a spongy  tissue,  which  arises  from  its  internal  face 
and  is  formed  of  filaments  and  little  laminae;  they,  by  cross- 
ing each  other,  form  a multitude  of  cells  which  have  a 
perfectly  free  communication,  and  generally  are  somewhat 
occupied  by  blood. 

The  Corpus  Spongiosum  Urethra!,  extends  from  ten  or 

16 


242 


OF  THE  TRUNK. 


twelve  lines  behind  the  junction  of  the  crura  of  the  corpus 
cavernosum,  to  the  anterior  extremity  of  the  penis.  Ex- 
ternally, it  is  covered  by  a coat  resembling  that  of  the  cor- 
pus cavernosum,  except  that  it  is  thinner.  In  its  centre,  is 
the  canal  for  the  urine.  Between  this  canal  and  the  coat  is 
a spongy  structure,  much  finer  than  that  of  the  corpus  caver- 
nosum, and  though  the  cells  communicate  freely,  still  they 
have  the  appearance  of  convoluted  veins.  The  corpus 
spongiosum  is  not  of  the  same  thickness  in  its  whole  course; 
its  commencement  in  the  perineum  where  it  is  pendulous, 
is  enlarged  into  what  is  termed  its  Bulb  ; from  this  it  di- 
minishes gradually  to  the  end  of  the  corpus  cavernosum, 
where  it  is  again  enlarged  into  the  Gians  Penis.  The 
transverse  diameter  of  the  glans  being  larger  than  that  of  the 
body  of  the  penis,  it  forms  all  around  a projecting  shoulder, 
the  Corona  Glandis.  The  surface  of  the  glans  is  covered 
by  thin  skin,  making  a very  delicate  epithelium,  and  a great 
number  of  papillae  for  the  termination  of  nerves.  Numerous 
follicles  also  exist  about  the  corona  glandis,  to  secrete  the 
sebaceous  fluid  which  collects  there,  in  persons  who  are  not 
cleanly.  They  constitute  the  glandulae  odiriferae  Tysoni. 

The  Urethra,  is  a mucous  canal  whose  length  varies  ac- 
cording to  the  degree  of  erection  in  the  penis,  and  extends 
from  the  neck  of  the  bladder,  to  the  extremity  of  the  glans. 
It  has  several  curvatures  and  receives  in  its  course  the  ducti 
ejaculatorii,  the  excretory  ducts  of  Cowper’s  glands,  and 
the  mucous  lacunas  of  its  internal  membrane.  The  first 
part  of  this  canal  which  traverses  the  prostate  gland,  is 
about  fifteen  or  eighteen  lines  in  length  ; it  is  the  Prostatic 
portion,  and  is  well  supported  by  this  body,  although  its 
own  sides  are  very  thin.  On  its  inferior  surface,  is  the  Ye- 
rumontanum  or  Caput  Gallinaginis,  an  oblong  projection  of 
the  lining  membrane,  an  inch  in  length,  broad  behind  where 
it  commences  a little  in  advance  of  the  Uvula  Vesicae,  and 
coming  to  a point  very  gradually  before.  In  the  posterior 
ridge  of  the  caput  is  a long  cleft,  which  is  tire  orifice  of  a 
lacuna  observed  first  by  Morgagni;  and  on  the  front  surface 
on  each  side,  is  the  orifice  of  the  ductus  ejaculatorius.  On 
the  sides  of  the  caput  gallinaginis,  the  canal  of  the  urethra  is 
depressed  into  something  like  a cul-de-sac,  where  are  to  be 


MALE  PELVIS. 


243 


found  the  orifices  belonging  to  the  lacunae  of  the  prostate 
gland,  as  stated. 

Between  the  Prostate  and  the  Bulb,  is  the  Membranous 
Part  of  the  urethra,  about  eight  or  ten  lines  long ; it  is  un- 
protected except  by  a soft  covering,  which  seems  in  some 
measure  to  be  a mixture  of  gelatinous  matter  and  muscular 
fibre.  The  former  was  considered  by  Littre,  as  a glandular 
body  which  secreted  a viscid  humour  into  the  interior  of  the 
canal;  the  latter  probably,  is  the  part  described  by  Winslow 
as  the  inferior  prostatic  muscle,  which  arising  on  each  side 
of  the  membranous  canal,  goes  to  be  inserted  into  the  cor- 
responding branch  of  the  pubes,  near  the  symphysis.  The 
membranous  part  of  the  urethra  does  not  get  into  the  end  of 
the  bulb,  but  penetrates  it  from  above,  half  an  inch  or  more 
occasionally,  from  its  extremity,  just  below  the  junction  of 
the  crura  of  the  Corpus  Cavernosum. 

The  canal  varies  in  its  dimensions  ; at  its  commencement 
in  the  bladder  it  is  large ; it  then  contracts  at  the  back  of  the 
caput  gallinaginis,  and  immediately  enlarges  in  tire  fore  part 
of  the  prostate,  at  the  sides  of  the  urethral  crest.  The  mem- 
branous part  is  small ; the  canal  then  enlarges  in  the  bulb.  In 
the  body  of  the  penis,  the  canal  is  successively  diminished 
till  it  comes  almost  to  the  glans,  when  it  is  so  remarkably 
enlarged  as  to  get  the  name  of  Fossa  N avicularis ; it  termi- 
nates, finally  by  a short  vertical  slit  at  the  extremity  of  the 
glans. 

In  the  whole  length  of  the  canal,  there  are  two  whitish 
middle  lines,  one  above,  and  the  other  below,  and  in  the 
membranous  and  spongy  portions,  excepting  the  fossa  na- 
vicularis,  longitudinal  folds  of  the  lining  membrane  exist, 
which  are  effaced  by  distention.  In  the  upper  part  of  the 
canal,  there  are  a great  many  mucous  lacunae;  Loder,  in 
his  plates  has  marked  about  sixty-five;  there  is  one  parti- 
cularly large  in  the  upper  surface  of  the  fossa  navicularis, 
which,  it  is  said,  has  stopped  the  point  of  a bougie,  and  been 
mistaken  for  stricture. 

Sir  Everard  Home  formerly  communicated  to  the 
Royal  Society,  a highly  interesting  paper,  on  the  structure 
of  the  lining  membrane  of  the  urethra.  From  his  micro- 


244 


OF  THE  TRUNK. 


scopical  observations,  he  was  induced  to  think,  that  it  was 
muscular. 

Mr.  Shaw,  of  London,  has  described  a set  of  vessels  im- 
mediately on  the  outside  of  the  internal  membrane  of  the 
urethra,  which  when  empty,  are  very  similar  in  appear- 
ance to  muscular  fibres.  He  says  he  has  discovered 
that  these  vessels  form  an  internal  spongy  body  which 
passes  down  to  the  membranous  part  of  the  urethra,  and 
forms  even  a small  bulb  there.*  His  preparation,  being  a 
quicksilver  injection  of  the  part,  is  certainly  a very  satis- 
factory demonstration  of  their  existence:  yet  in  my  own 
observations,  I have  not  been  able  to  distinguish  them  from 
the  cellular  membrane,  connecting  the  canal  of  the  urethra, 
to  the  corpus  spongiosum. 

The  arteries  of  the  penis  come  from  the  internal  pudic ; 
some  of  the  veins  follow  the  course  of  the  arteries,  and 
others  collect  into  the  two  venae  dorsalis  penis:  the  nerves 
come  from  the  Superior  and  Inferior  Pudendal. 


OF  THE  TESTICLES,  (TESTES.) 

These  bodies,  two  in  number,  are  surrounded  by  seve- 
ral coats,  the  most  external  of  which,  is  common  to  both 
the  testicles,  and  is  called  Scrotum;  the  others  are  called 
the  Dartos,  Tunica  Vaginalis,  and  Tunica  Albuginea. 
The  Scrotum  is  a sac  formed  by  a continuation  of  skin 
from  the  internal  sides  of  the  thighs,  from  the  inferior  part 
of  the  penis,  and  from  the  anterior  part  of  the  perineum. 
It  is  very  thin,  darker  than  the  rest  of  the  skin,  sparingly 
covered  with  hairs,  has  many  sebaceous  follicles  in  it, and 
is  closely  united  to  the  cellular  membrane  beneath.  It  is 
very  extensible,  and  has  a great  power  of  contraction,  its 
surface  being  covered  with  wrinkles  which  are  more  ap- 
parent when  it  is  contracted.  It  consists  of  two  symme- 
trical halves,  marked  off  from  each  other  bv  an  elevation  of 
skin,  the  Raphe,  which  extends  from  the  perineum  over 
the  scrotum,  along  the  inferior  surface  of  the  penis,  to  the 
end  of  the  latter. 

Beneath  the  scrotum  is  the  Dartos,  a fibrous  membrane 


* See  Med.  Chir.  Trans,  rol.  x. 


MALE  PELVIS. 


245 


which  is  vascular,  reddish,  and  deprived  of  fat;  it  arises 
from  the  inferior  margins  of  the  crura  of  the  ischia  and 

o ....  ... 

pubes,  and  passing  downwards,  it  joins  the  raphe  ; it  is 
then  reflected  upwards,  forms  a septum  between  the  two 
sides  of  the  scrotum,  and  goes  up  to  the  inferior  part  of  the 
urethra.  This  membrane  has  been  confounded  with  cel- 
lular substance;  but  it  appears  from  the  reports  of  Mes- 
sieurs Chaussier,  Lobstein,  and  Breschet,  that  it  does  not 
exist  in  the  scrotum  till  the  descent  of  the  testicle,  and 
that  it  is  an  expansion  of  the  gubernaculum  testis. 

Notwithstanding  its  great  contractility,  the  question  of 
its  muscular  structure  is  not  settled,  and  certainly  in  the 
greater  part  of  its  extent,  there  is  not  the  appearance  of 
muscular  fibre;  but  at  its  posterior  end,  just  at  the  anterior 
point  of  the  sphincter  ani,  I have  often  seen  a broad  mus- 
cular expanse,  the  character  of  which  could  scarcely  be 
misconceived.*  The  contractility  of  the  scrotum  has 
been  attributed  to  the  cremaster  muscle,  instead  of  this 
membrane,  but  common  observation  will  convince  most 
persons,  that  the  elevation  of  the  testicles  in  the  scrotum 
by  the  contraction  of  the  cremasters,  is  very  distinguish- 
able from  that  contraction  of  the  scrotum,  by  which  the 
testicles  are  squeezed  against  the  sides  of  the  pubes,  and 
the  scrotum  brought  into  a hard  corrugated  mass. 

The  Cremaster  Muscle  is  an  imperfect  coat,  and 
belongs  rather  to  the  spermatic  cord;  its  course  has  been 
explained  in  the  account  of  the  abdominal  muscles.  Its 
fibres  are  much  separated  on  the  tunica  vaginalis ; they 
lay  on  its  front  part,  and  on  the  internal  and  external 
sides  of  the  spermatic  cord.  Within  the  last,  is  a coat  of 
cellular  substance,  the  Tunica  Vaginalis  Communis,  which 
connects  the  dartos  and  the  cremaster  muscle,  with  the 
tunica  vaginalis. 

The  Tunica  Vaginalis  Testis,  was  originally  a process 
of  peritoneum,  though  it  appears  in  the  adult  as  a com- 
plete sac.  The  testicle  being  protruded  into  it  from  behind, 
one  half  of  the  sac  applies  itself  closely  to  the  epididymis  and 
testicle,  while  the  other  half  is  loose;  the  whole  arrangement 

* I have  dissected  one  subject  since  this,  (Jan.  1839,)  where  the 
■fibres  were  evidently  muscular,  though  interwoven. 


246 


OF  THE  TRUNK. 


being  precisely  after  the  manner  of  a double  night-cap 
when  drawn  over  the  head.  It  passes  up  some  distance 
on  the  cord ; its  cavity  is  smooth,  polished  and  moistened 
by  a synovial  halitus,  which  allows  the  surfaces  to  move 
freely  upon  each  other.  This  cavity  may  be  injected  with 
but  little  force,  so  as  to  hold  an  ounce  or  more  of  fluid. 
It  is  the  seat  of  Hydrocele. 

The  Tunica  Albuginea,  is  the  proper  coat  of  the  testicle, 
preserves  its  form,  and  is  in  immediate  contact  with 
the  glandular  structure.  It  is  a dense,  strong,  white 
fibrous  membrane,  corresponding  very  much  in  its  gene- 
ral characters  with  the  tunica  sclerotica  of  the  eye.  From 
the  internal  surface  of  the  albuginea,  several  membranous 
processes,  forming  partial  partitions,  (Septulae  Testes)  pass 
off)  and  terminate  at  the  posterior  part  of  the  cavity  in  the 
Corpus  Highmorianum.  These’septulae,  conduct  the  blood- 
vessels through  the  substance  of  the  gland,  and  form  little 
apartments,  which  support,  confine,  protect,  and  nourish 
the  tubular  structure  of  the  testes.  The  Corpus  Highmo- 
rianum is  a longitudinal  projection  of  the  tunica  albuginea, 
somewhat  broader  above  than  below;  its  upper  part  is 
perforated  by  the  vasa  efferentia. 

The  form  of  the  Testicles  as  communicated  by  the  tu- 
nica albuginea,  is*  very  much  that  of  an  oval,  somewhat 
compressed  laterally,  the  edges  presenting  forwards  and 
backwards;  they  do  not  hang  with  the  long  diameter  ver- 
tical, but  the  upper  end  is  advanced  a little  forwards,  and 
the  lower  points  somewhat  backwards.  They  are  both  of 
the  same  size  generally,  but  in  case  of  a difference  the 
right  is  larger;  it  is  also  higher  up  than  the  left,  a circum- 
stance which  has  been  marked  by  sculptors  in  all  ages. 

The  glandular  structure  of  the  testicle,  consists  of  a 
congeries  of  zig  zag  tubes,  (Tubuli  Seminiferi)  stated  by 
Monro  to  amount  to  three  hundred,  whose  diameters  do 
not  exceed  individually  the  one  two-hundreth  part  of  an 
inch,  and  when  extended  to  their  full  length,  would  form 
in  the  aggregate,  a tube  5208  feet  long.  These  tubes,  al- 
most inconceivably  fine  as  they  are,  can  be  injected  in  a 
retrograde  course  through  the  vas  deferens,  with  mercury, 


MALE  PELVIS. 


247 


bui  the  task  is  one  of  exceeding  difficulty,  and  scarcely 
ever  succeeds  fully. 

The  Tubuli  Seminiferi,  it  has  been  stated,  fill  up  nearly 
the  whole  of  the  cavity  of  the  Albuginea,  being  kept  from 
each  other  by  the  processes  termed  Septulae.  These  tubes 
send  out  a great  number  of  trunks,  which,  from  their  ob- 
serving a straight  course,  obtain  the  name  of  Yasa  Recta. 
These  vasa  recta  unite  near  the  centre  of  the  testicle,  and 
form  a net-work,  the  Rete  Testis.  From  the  rete  testis 
there  proceed  from  twelve  to  eighteen  tubes,  which  pass 
through  the  upper  part  of  the  corpus  highmorianum,  and 
get  to  the  outside  of  the  tunica  albuginea;  these  are  the 
Vasa  Efferentia.  Each  of  these  vasa  is  rolled  up  exter- 
nally at  this  place,  so  as  to  give  the  outline  of  a cone, 
therefore,  it  gets  the  name  of  Conus  Vasculosus.  Each 
cone  successively  empties  into  a single  tube  on  the  back 
of  the  testis,  which  is  prodigiously  convoluted  and  forms 
a large  body,  the  Epididymis. 

The  Epididymis,  is  a prismatic  arch  enlarged  at  both  ex- 
tremities, and  resting  vertically  on  the  back  of  the  testicle, 
being  connected  with  it,  by  the  tunica  vaginalis.  The 
enlargement  above,  is  the  Globus  Major,  and  is  formed 
of  the  coni  vasculosi,  but  what  remains  of  this  body  below, 
consists  of  one  tube  excessively  convoluted.  The  enlarge- 
ment below,  is  the  Globus  Minor;  after  this  is  formed,  the 
tube  becomes  less  convoluted  and  turns  upwards  on  the  in- 
side of  the  epididymis,  and  a little  farther  on,  it  becomes 
nearly  straight,  and  is  called  Vas  Deferens.  There  is  a 
blind  duct  which  commences  at  the  top  of  the  epididymis 
and  terminates  below,  the  intention  of  which,  is  not 
known.  It  is  called  the  Vasculum  Aberrans  Halleri,  and 
varies  in  length  from  one  and  a half  to  fourteen  inches.  Its 
use  is  unknown. 

The  Vas  Deferens,  is  a white  tube  about  a half  line  in 
diameter,  having  a cartilaginous  feel ; its  cavity  is  large 
enough  to  admit  a bristle.  It  passes  on  the  back  of  the 
spermatic  cord,  and  continues  with  it  through  the  abdomi- 
nal canal ; at  the  internal  ring  it  leaves  the  residue  of  the 
cord,  and  dipping  into  the  pelvis  by  the  side  of  the  bladder, 


248 


OF  THE  TRUNK. 


goes  between  it  and  the  ureter  to  the  lower  fundus,  ap- 
proaching its  fellow,  on  the  inside  of  the  vesiculse  seminales, 
and  ending  in  the  urethra,  by  the  Ductus  Ejaculatorius. 
About  two  and  a half  inches  from  its  termination  it  becomes 
somewhat  tortuous  and  enlarges. 


Fig.  50. 


A View  of  the  Minute  Structure  of  the 
Testis. 

1.1.  Tunica  Albuginea. 

2.2.  Corpus  Highmorianum. 

3.3.  Tubuli  Seminiferi,  convoluted  into  Lobules. 

4.  Vasa  Recta. 

5.  Rete  Testis. 

6.  Vasa  Efferentia. 

7.  Coni  Vasculosi,  constituting  the  Globus  Ma- 

jor of  the  Epididymis. 

8.  Body  of  the  Epididymis. 

9.  Its  Globus  Minor. 

10.  Vas  Deferens. 

11.  Vasculum  Aberrans  or  Blind  Duct. 


The  Spermatic  Cord  is  formed  of  the  Vas  Deferens,  the 
Spermatic  Artery  and  Veins,  Lymphatics,  Nerves,  and  Cel- 
lular membrane,  all  covered  by  the  Cremaster  muscle.  The 
artery  arises  from  the  aorta  and  retains  its  first  size  till  it 
arrives  at  the  testis,  it  then  divides,  some  of  its  branches 
being  spent  on  the  epididymis,  and  the  remainder  going 
into  the  testis,  and  terminating  on  the  tubes.  The  veins  in 
ascending,  form  a remarkable  plexus,  the  Corpus  Pampini- 
forme;  at  the  internal  ring  they  unite  into  one  trunk,  which 
on  the  right,  joins  the  ascending  cava,  and  on  the  left,  the 
emulgent  vein. 

Having  thus  become  acquainted  with  the  structure  of  the 
viscera  of  the  male  pelvis,  I advise  the  student,  in  the  next 
place,  to  put  the  subject  in  the  posture  recommended  for  Li- 
thotomy, in  order  that  he  may  work  on  the  Perineum. 


MALE  PELVIS. 


249 


SECTION  II. 

Of  the  Perineum  and  the  Fascia  of  the  Male  Pelvis. 

The  subject  being  fixed  in  the  posture  indicated,  make 
a horizontal  cut  through  the  skin,  at  the  junction  of  the 
raphe  of  the  perineum  with  the  scrotum,  extending  it  on 
each  side  three  inches ; make  another  transverse  cut  of  the 
same  length  over  the  end  of  the  os  coccygis;  drop  a perpen- 
dicular cut,  equally  profound  with  the  first,  from  its  middle 
to  the  point  of  the  os  coccygis.  The  skin  constituting  the 
flap  on  each  side  being  raised  up  carefully,  so  as  not  to  in- 
jure subjacent  parts,  when  the  two  flaps  are  pinned  aside, 
the  structure  of  the  perineum  is  sufficiently  opened  for  the 
time. 

The  Perineal  Fascia  is  first  exposed  ; it  occupies  nearly 
all  the  space  between  the  anus  and  the  posterior  margin  of 
the  scrotum,  insensibly  blending  with  the  latter ; and  be- 
tween the  rami  of  the  pubes  and  of  the  ischia,  being  very 
firmly  fixed  to  these  bones.  This  fascia,  in  case  of  rup- 
ture in  the  posterior  part  of  the  urethra,  prevents  the  urine 
from  showing  itself  in  the  perineum,  and  drives  it  into  the 
cellular  structure  of  the  scrotum.  In  abscesses  of  the  pe- 
rineum, it  also  prevents  the  fluctuation  from  being  very  evi- 
dent. Having  studied  well  its  connexions,  structure,  and 
influence,  it  is  to  be  raised  up,  and  turned  to  each  side  by 
a cut  down  its  middle,  in  order  to  bring  into  view  the  Pe- 
rineal muscles. 

The  Musculus  Erector  Penis,  is  so  situated  as  to  cover 
the  whole  of  the  crus  of  the  penis,  which  is  not  in  contact 
with  the  bony  margin  of  the  pelvis.  It  arises,  therefore, 
from  the  anterior  part  of  the  tuber  ischii,  tendinous  and 
fleshy ; its  fleshy  fibres,  adhering  to  the  internal  and  exter- 
nal margins  of  the  rami  of  the  pubes  and  ischium,  proceed 
upwards,  and  just  before  the  union  of  the  crura  of  the  pe- 
nis, end  in  a flat  tendon  which  is  lost  on  the  side  of  the 
corpus  cavernosum  of  the  penis.* 

* The  late  Dr.  Lawrence  informed  me  that  he  has  frequently  found 
muscular  fibres  between  the  bone  and  the  crus  penis. 


250 


OF  THE  TRUNK. 


Its  use  is  not  well  understood. 

The  Accelerator  Urin.e  Muscle,  lies  on  the  bulb  and 
back  part  of  the  corpus  spongiosum  urethrae ; ix  is  a thin 
muscle  consisting  of  oblique  fibres. 

It  arises  by  a pointed  production  from  the  side  of  the 
body  of  the  penis ; its  origin  is  continued  obliquely  across 
the  inferior  surface  of  the  crus  penis,  where  the  latter  begins 
to  form  the  body  of  the  penis.  It  arises  also  from  the  in- 
ner side  of  the  ramus  of  the  pubes,  between  the  crus  penis 
and  the  triangular  ligament  of  the  urethra.  The  muscles 
of  the  opposite  sides,  are  inserted  into  each  other,  by  a white 
line  which  marks  the  middle  of  the  bulb  of  the  urethra,  and 
by  a point,  into  the  anterior  extremity  of  the  sphincter  ani, 
where  they  are  joined  by  the  transversi  perinei. 

In  order  to  see  the  origin  of  these  muscles  very  distinctly, 
separate  them  from  each  other  in  the  middle  line,  and  dissect 
them  from  the  corpus  spongiosum.  Cut  transversely  through 
the  corpus  spongiosum,  about  three  inches  before  the  trian- 
gular ligament,  and  dissect  it  clearly  from  the  corpus  caver- 
nosum,  turning  it  downwards  so  that  it  may  hang  by  the 
membranous  part  of  the  urethra.  By  putting  the  two  ac- 
celerators on  the  stretch,  it  will  be  seen,  that  besides  the 
origins  mentioned,  they  arise  also  from  each  other  by  a ten- 
dinous membrane  that  is  interposed  between  the  corpus 
spongiosum  and  cavernosum,  so  that  they  literally  surround 
the  posterior  part  of  the  urethra,  constituting  a complete 
sphincter  muscle  for  it.  This  account  of  the  accelerator 
urinae,  being  peculiar  to  myself,  is  adopted  from  a strong 
analogy  between  it  and  the  sphincter  vagina. 

These  two  muscles  are  considered  by  M.  Chaussier,  as 
forming  but  one  ; in  that  case  its  origin  will  be  reversed, 
and  commence  in  the  middle  line  of  the  perineum,  instead 
of  terminating  there.  The  relation  of  this  muscle  and  the 
erector  penis  should  be  observed,  in  order  to  appreciate  the 
difficulty  of  getting  into  the  membranous  part  of  the  urethra, 
in  lithotomy,  without  cutting  through  the  muscular  fibres  of 
one  or  the  other. 

It  propels  the  urine  and  semen  forward. 

The  Transversus  Perinei  Muscle,  as  its  name  implies, 
passes  directly  across  the  perineum  ; it  arises  from  tire  in- 


MALE  FELVIS. 


251 


ner  side  of  the  ischium  just  at  the  origin  of  the  erector  penis, 
and  is  inserted  where  the  sphincter  ani  and  the  acceleratores 
urinse  join. 

I have  observed,  that  when  the  lower  part  of  the  accele- 
rator was  extended  much  below  its  usual  line,  and  strongly 
developed,  that  the  transversus  was  very  irregular  in  its 
origin  and  course,  consisting  frequently  of  a few  fibres  which 
did  not  deserve  the  name  of  a distinct  muscle,  and 
were  almost  unappropriated  in  the  adipose  matter  of  the 
part. 

Occasionally,  a fasciculus  of  muscular  fibres  exists,  called, 
by  Albinus,  Transversus  Perinei  Alter,  which  arises  in  front 
of  the  first,  and  is  inserted  into  the  perineal  junction,  just  be- 
hind it.  It  seems  generally  to  be  a loose  fasciculus  of  the 
accelerator  urinae  muscle. 

The  use  of  these  muscles  seems  to  be,  to  contribute  to  fix 
the  bulb  of  the  urethra. 

The  Sphincter  Ani  muscle,  consists  in  a plane  of  fibres 
which  surrounds  the  anus,  in  order  to  keep  it  closed.  The 
long  diameter  of  the  elipsis  is  extended  from  the  coccyx  to- 
wards the  symphysis  pubis,  and  has  its  angles  very  much 
elongated ; the  anterior,  may  be  traced  terminating  insensi- 
bly in  the  posterior  face  of  the  scrotum.  It  has  two  fixed 
points,  the  last  bone  of  the  os  coccygis  behind,  and  the  pe- 
rineal union  of  the  other  muscles  in  front;  its  lateral  diameter 
occupies  about  one  half  of  the  space  between  the  tuberosities 
of  the  ischia,  as  it  is  in  the  middle  of  this  space.  The  point 
of  it  in  front,  is  continued  into  the  dartos. 

Besides  closing  the  orifice  of  the  rectum,  it  will  draw  the 
bulb  of  the  urethra  backwards,  or  the  point  of  the  os  coc- 
cygis forwards. 

The  Coccygeus  Muscle  rather  belongs  to  the  interior  of 
the  pelvis,  but  is  seen  well  enough  here.  It  arises  by  a 
small,  tendinous,  and  fleshy  beginning,  from'1  the  spine  of 
the  ischium,  and  lying  on  the  anterior  face  of  the  anterior 
sacro-sciatic  ligament,  is  inserted  into  the  side  of  the 
last  bone  of  the  sacrum,  and  into  all  those  of  the  os  coc- 
cygis. 

It  draws  the  os  coccygis  forwards. 


252 


OF  THE  TRUNK. 


It  frequently  happens  that  there  is  on  each  side,  a small 
fasciculus  of  muscle,  arising  from  the  inferior  bone  of  the 
Sacrum  in  front,  and  inserted  into  the  bones  of  the  coccyx. 
It  is  called  the  Sacro-Coccygeus. 

A View  of  the  Muscles  of  the  Perineum  of  the  Male. 

The  parts  on  one  side  only  are  referred  to. 

Fig.  51. 


1.  Ascending  Ramus  of  the  Ischium. 

2.  Tuber  Ischii. 

3.  Posterior  Face  of  the  Coccyx. 

4.  Portion  of  the  Great  Sacro-Sciatic  Ligament. 

5.  Musculus  Accelerator  Urince. 

6.  Erector  Penis  Muscle. 

7.  Transversus  Perinei. 

8.  Sphincter  Ani. 

9.  Levator  Ani. 

10.  Musculus  Coccygeus. 

11.  Section  of  the  Gluteus  Magnus. 

12.  Adductor  Longus. 

13.  Adductor  Brevis. 

14.  Adductor  Magnus. 

15.  Extremity  of  the  Gluteus  Magnus. 

16.  The  Urethra. 

17.  Corpora  Cavernosa  turned  up. 

18.  Spermatic  Cord  turned  up. 

19.  Free  Extremity  of  the  Penis  with  its  Integuments. 


MALE  PELVIS. 


253 


The  Erectores  Penis,  Acceleratores  U rinse,  and  Trans- 
versi  Perinei,  are  now  to  be  removed.  A large  quantity  of 
adipose  and  cellular  matter  will  then  be  found  on  each 
side  of  the  rectum,  between  it  and  the  parietes  of  the  pel- 
vis, concealing  the  levatores  ani  muscles.  This  fat  is  bet- 
ter left  in  situ  for  the  present. 

The  muscles  being  removed,  the  bulb  of  the  urethra  is 
seen  to  great  advantage,  extending  in  the  middle  of  the  pe- 
rineum almost  to  the  anus.  It  is  not  loose  and  pendulous 
as  described,  but  is  connected  by  its  superior  face  to  the 
Triangular  Ligament  of  the  urethra,  a membrane  which  fills 
up  the  space  below  the  symphysis  of  the  pubes.  This  liga- 
ment is  a septum  between  the  perineum  and  pelvis,  and, 
when  closely  examined,  is  seen  to  connect  itself  to  the  in- 
ternal edges  of  the  rami  of  the  pubes  and  ischia,  at  the  in- 
ner posterior  sides  of  the  crura  penis,  as  far  down  as  the 
beginning  of  the  latter.  At  its  lower  edge,  its  ligamentous 
character  is  not  so  well  defined.  It  extends  from  the  top 
of  the  pubic  arch,  downwards  an  inch  and  a half,  filling  up 
all  the  intermediate  space  between  the  bones.  On  its  an- 
terior surface  is  the  bulb  of  the  urethra,  and  just  at  the  ex- 
tremity of  the  latter,  enclosed  by  the  ligament  and  adhering 
to  it,  are  Cowper’s  Glands.  A.  perforation  exists  in  it 
through  which  passes  the  membranous  part  of  the  urethra. 
To  get  a view  of  this  opening,  the  corpus  spongiosum,  if  not 
already  detached,  must  be  cut  through,  an  inch  anterior  to 
the  symphysis  pubis,  dissected  carefully  from  the  corpus 
cavernosum,  and  turned  down  on  the  perineum.  The 
opening  at  first  is  not  very  apparent,  in  consequence  of  its 
edges  being  continued  a little  distance  on  the  canal,  but 
by  detaching  them  the  hole  becomes  well  defined. 

Here  it  becomes  necessary  to  attend  to  the  relative  situa- 
tion of  the  bulb,  and  of  the  membranous  part  of  the  urethra. 
The  former  has  just  been  described  going  towards  the  anus; 
the  latter  passes  upwards  towards  the  neck  of  the  bladder ; 
they  consequently  form,  a considerable  angle  with  each 
other,  and  the  membranous  part  of  the  urethra  is  much  the 
deeper ; the  recollection  of  this  is  all  important  in  litho- 
tomy, as  it  teaches  us  to  avoid  tire  one,  and  to  cut  into  the 


254 


OF  THE  TRUNK. 


other.  It  will  also  be  observed,  that  the  hole  in  the  trian- 
gular ligament  is  an  inch  below  the  symphysis  pubis. 

By  dissecting  off  the  upper  corner  of  the  triangular  liga- 
ment, we  are  made  acquainted  with  another  just  behind  it, 
which  is  totally  distinct.  This  ligament  is  half  an  inch 
broad,  thick  and  strong,  particularly  at  its  lowrer  edge,  and 
is  very  firmly  attached  laterally  to  each  pubes,  just  below 
the  symphysis.  Mr.  Colies  calls  it  pubic  ligament,  with 
great  propriety.  I would  suggest,  as  somewhat  more  ex- 
pressive, the  term  Inter-Pubic  ligament,  as  it  serves  to  dis- 
tinguish it  from  another  called  pubic,  which  is  above  the 
pubes.*  The  breadth  of  this  having  been  stated  at  half  an 
inch,  it  is  obvious  that  the  hole  in  the  triangular  ligament  is 
half  an  inch  below  the  lower  edge  of  the  inter-pubic. 

We  have  now  seen,  as  much  as  can  be  viewed  advan- 
tageously from  the  perineum,  at  this  stage  of  the  dissection, 
and  I recommend  an  inspection  of  the  parts  from  above,  on 
the  side  of  their  abdominal  surfaces.  The  pelvis  is  there- 
fore to  be  separated  from  the  trunk  at  the  last  lumbar  verte- 
bra, and  the  posterior  part  of  the  pelvis  removed,  by  saw- 
ing through  the  os  ilium,  from  its  crista  to  the  upper  margin 
of  the  sciatic  notch  on  each  side ; the  os  coccygis  however 
must  remain  in  situ,  as  it  is  very  material  to  the  description 
of  the  Levator  Ani  muscle.  Care  must  be  taken  not  to  in- 
jure the  rectum  in  these  sections. 

Begin  by  raising  the  peritoneum  from  the  anterior  surface 
of  the  rectum,  after  which  by  letting  the  rectum  fall  back- 
wards and  putting  the  raised  peritoneum  on  the  stretch,  an 
excellent  view  is  obtained  of  the  line  of  attachment  of  the 
latter,  to  the  lower  part  of  the  bladder.  It  is  seen,  that  die 
peritoneum  is  reflected  from  the  bladder  at  the  posterior 
end  of  the  vesiculse  seminales,  but  that  a pouch  or  process 
of  it  is  sent  down  between  them,  which  reaches  to  a short 
distance  from  the  prostate  gland,  and  that  below  this  process 
of  the  peritoneum,  a very  small  space  of  the  bladder  lies 
naked,  which  can  be  punctured  from  the  rectum,  w ithout  in- 
juring either  the  cavity  of  the  peritoneum  or  the  vesiculas 
seminales.  The  upper  margin  of  this  pouch  next  to  the 


* See  Abdominal  Muscles. 


MALE  PELVIS. 


255 


bladder  forms  a strong  horizontal  doubling,  stretching  across 
the  pelvis,  when  the  rectum  is  empty. 

By  distending  the  bladder  moderately,  the  different  re- 
flections of  the  peritoneum  from  it  to  the  abdominal  parietes, 
and  to  those  of  the  pelvis,  will  be  better  understood,  and 
the  possibility  of  puncturing  the  former  above  the  pubes, 
without  getting  into  the  cavity  of  the  abdomen,  will  be  de- 
monstrated fully,  as  well  as  the  freedom  with  which  its 
neck  may  be  divided,  in  the  lateral  operation  for  the  stone. 


Next  strip  the  peritoneum  from  the  sides  of  the  pelvis, 
which  brings  into  view  the  Aponeurosis  Pelvica  connecting  the 
bladder  to  the  sides  of  the  innominata.  “ This  fascia  descends 
from  the  ilio-pectineal  line,  to  about  midway  in  the  depth  of 
the  pelvis ; here  it  is  reflected  from  the  surface  of  the  mus- 
cles (the  Levator  Ani)  and  applies  itself  to  the  prostate 
gland  and  bladder,  on  the  body  of  which  it  is  ultimately 
lost.  At  the  angle  of  its  reflection,  this  fascia  appears  par- 
ticularly strong  and  white,  but  becomes  more  weak  and 
thin  as  it  lines  the  muscles  and  covers  the  bladder.  In 
tracing  this  membrane,  it  will  be  seen  that  from  the  pubes 
just  below  the  symphysis,  a pointed  production  of  it  con- 
stituting its  anterior  margin  is  fixed  into  the  side  of  the 
neck  of  the  bladder.  This  pointed  production  on  each 
side  is  called  by  most  anatomistst,  the  Anterior  Ligament  of 
the  bladder.  Between  the  two,  just  beneath  the  symphysis 
of  the  pubes,  a pouch  large  enough  to  receive  the  end  of 
the  finger,  is  formed  by  the  union  of  the  fascia  of  the  two 
sides;  this  pouch  connects  the  middle  anterior  part  of  the 
neck  of  the  bladder  to  the  lower  margin  of  the  symphysis 
pubis.” 

A good  account  of  this  fascia  was  published  by  M.  Bres- 
chet.*  He  says,  u that  when  the  aponeurosis  which  covers 
the  iliac  fossa  arrives  at  the  internal  margin  of  the  iliacus 
internus  and  psoas  magnus  muscles,  near  the  superior  strait 
of  the  pelvis,  it  plunges  into  this  cavity  in  order  to  line  its 
sides,  and  to  cover  the  muscles  which  are,  applied  on  its 
several  openings.  Having  got  very  low  down  it  embraces 


* Thesis  on  Hernia,  p.  310,  presented  to  the  Faculty  of  Medicine 
in  Paris  for  the  place  of  Chef  des  Travaux  Anatomiques,  in  the  year 

1819. 


256 


OF  THE  TRUNK. 


the  rectum,  is  reflected  upon  the  bas-fond  of  the  bladder, 
the  prostate  gland,  and  in  woman  upon  the  vagina.  From 
which  cause,  these  viscera  may  be  said  to  be  in  part  in  the 
cavity  of  the  pelvis,  and  partly  out  of  it,  if  we  consider 
this  cavity  as  the  space  on  the  outside  of  the  aponeurosis. 
Some  practitioners  have  observed,  that  the  consequences  of 
the  operation  of  lithotomy  are  different  when  the  instrument 
penetrates  more  or  less  deeply  behind  or  on  the  side.  In- 
flammations, suppurations,  abscesses  in  the  cavity  of  the 
pelvis  occur,  when  the  instrument  is  thrust  in  too  much, 
while  no  such  accidents  follow  an  instrument  introduced 
moderately  deep.  Some  distinguished  practitioners*  have 
asked  the  reason  of  these  differences,  and  I believe  that  I 
have  found  them  in  the  arrangement  of  the  aponeurosis 
pelvica.  If  the  instrument  does  not  penetrate  beyond  this 
fascia,  there  is  no  abscess  in  the  pelvis,  or  if  a small  quan- 
tity of  pus  be  formed,  it  readily  finds  an  issue  externally. 
On  the  contrary,  if  the  pelvic  aponeurosis  be  injured,  in- 
flammation developes  itself,  suppuration  takes  place  beyond 
this  aponeurotic  barrier,  the  liquid  cannot  get  out,  and  it 
makes  ravages  which  sometimes  cause  the  death  of  the 
patient.” 

This  description  of  the  aponeurosis  pelvica  is  true,  but 
rather  too  general;  the  most  common  condition  of  it  is 
found  to  be  as  follows.  It  adheres  closely  to  the  perios- 
teum of  the  pubes,  between  the  upper  margin  of  the  thyroid 
foramen  and  the  crista  of  the  pubes  ; about  the  middle  third 
of  the  linea  innominata,  it  is  obviously  a continuous  mem- 
brane with  the  iliac  fascia,  but  behind  this  again,  it  arises 
from  the  remaining  third  of  the  linea  innominata. 

The  portion  of  this  fascia  which  Mr.  Colles  speaks  of,  as 
particularly  strong  and  white,  forms  a bow,  the  concavity 
of  which  looks  upwrards,  one  end  of  the  bow' being  fastened 
to  the  pubes  above  the  foramen  thyroideum,  and  the  other 
end  to  the  ischium  above  its  spine.  The  perineal  surface 
of  this  bowT,  is  an  important  point  of  the  origin  of  the  leva- 
tor ani.  Above  the  bow  this  fascia  is  very  thin,  for  the 
fibres  of  the  obturator  internus  can  be  readily  seen 
through  it. 

At  the  bow  this  fascia  divides  into  two  laminae,  one  having 

* Scarpa’s  Memoir  on  Hawkin’s  Gorget. 


MALE  PELVIS. 


257 


the  course  to  the  bladder  and  rectum  indicated,  the  other 
covers  the  lower  part  of  the  obturator  internus  muscle  and 
constitutes  the  obturator  fascia.  The  levator  ani,  is  inter- 
posed between  the  laminae.  The  aponeurosis  pelvica,  also 
forms  a bow  or  semilunar  edge  in  front  of  the  sacral  nerves. 
The  triangular  ligament  and  this  fascia  are  so  identified  in 
forming  the  capsule  of  the  prostate  gland,  that  the  latter  in 
description,  may  be  referred  either  to  the  one  or  the  other, 
or  to  both,  according  to  the  fancy  of  the  describer. 

The  Levator  Ani  muscle,  is  essentially  connected  with  the 
aponeurosis  pelvica.  In  order  then  to  get  a view  of  it, 
make  a cut  through  the  fascia,  from  the  symphysis  pubis 
backwards  to  the  sciatic  notch,  about  half  an  inch  above  the 
middle  of  the  fascia.  As  the  muscle  is  placed  nearer  to  the 
perineum,  the  fascia  must  be  turned  down  towards  the  blad- 
der as  low  as  possible,  the  upper  surface  of  the  muscle  is 
thus  exposed,  and  also  the  manner  in  which  it  may  be  said 
to  arise,  particularly  at  its  posterior  part,  from  the  under,  or 
perineal  surface  of  the  fascia. 

The  Levator  Ani  muscle,  arises  fleshy  from  the  back  of 
the  pubes  near  its  symphysis,  and  from  near  the  superior 
margin  of  the  foramen  thyroideum,  above  the  obturator  in- 
ternus muscle.  It  also  arises  from  the  aponeurosis  pelvica, 
where  this  membrane  is  extended  as  a thickened  semilunar 
cord,  from  the  superior  margin  of  the  thyroid  foramen  to  the 
spinous  process  of  the  ischium.  This  second  part  of  the 
origin  of  the  levator  ani,  is  defectively  described  in  most 
books  on  anatomy.  It  is  then  seen  to  cross  obliquely,  as 
far  as  the  spine  of  the  ischium,  that  portion  of  the  obturator 
internus  which  arises  from  the  plane  of  the  ischium. 

From  this  extensive  origin  the  fibres  converge,  descend 
backwards,  and  have  three  distinct  places  of  insertion ; 
the  posterior  fibres  are  inserted  into  the  last  two  bones  of 
the  os  coccygis ; the  middle,  and  by  far  the  greater  number, 
are  inserted  into  the  semi-circumference  of  the  rectum,  be- 
tween its  longitudinal  fibres  and  the  circular  fibres  of  the 
sphincter  ani;  and  finally,  the  most  anterior  fibres,  pass  ob- 
liquely downwards  and  backwards,  on  the  side  of  the  vesical 
end  of  the  membranous  part  of  the  urethra,  and  on  the  side 
of  the  prostate  gland,  and  are  inserted  into  the  common 
point  of  the  perineal  muscles.  These  insertions  of  the 
17 


258 


OF  THE  TRUNK. 


levator  ani,  to  be  well  understood,  must  be  studied  both 
from  the  perineal  and  abdominal  surfaces.  The  fore-part 
of  this  muscle  is  by  some  of  the  English  anatomists,  called 
the  Compressor  Urethrae.* 

It  yet  remains  to  speak  more  definitely  of  the  Triangular 
Ligament;  it  has  been  seen  from  the  perineum,  and  is  now 
to  be  viewed  from  the  pelvis.  Remove  the  anterior  part  of 
the  levator  ani ; the  ligament  is  then  seen  occupying  the  in- 
terval under  the  symphysis,  and  between  the  rami  of  the 
pubes  and  ischia.  Its  base  or  inferior  edge  is  crescentic; 
and  half  an  inch  above  the  base,  is  the  hole  for  the  mem- 
branous part  of  the  urethra.  This  hole,  is  in  fact,  not  very 
distinct,  for  the  triangular  ligament  is  reflected  backwards 
from  its  edges,  along  the  membranous  part  of  the  urethra, 
which  obscures  the  hole.  The  prostate  gland  also  gets  a 
ligamentous  capsule  from  a continuation  of  this  same  reflec- 
tion, and  is  thereby  very  firmly  fixed  in  its  place. 

The  edges  of  the  triangular  ligament,  fastened  to  the 
side  of  the  pubic  arch,  are  continuous  with  the  fascia  cover- 
ing the  obturator  internus  muscle.  The  triangular  ligament 
is  a membrane  consisting  of  two  laminge ; the  bulb  of  the 
urethra  is  fastened  to  the  anterior  lamina,  and  the  prostate 
is  fixed  to  the  posterior  lamina;  between  these  laminae 
above,  is  the  interpubic  ligament,  and  several  blood-vessels 
derived  from  the  vena  ipsius  penis. 

Mr.  Colles  says:  “if  we  attempt,  in  conformity7  to  the 
custom  of  anatomical  writers,  to  describe  all  these  continu- 
ous fasciae  which  connect  the  bladder  and  urethra  to  tire 
pubes,  as  productions  of  one  and  the  same  fascia,  we  might 
say  that  the  triangular  ligament,  by  its  outer  edges,  is  fixed 
into  the  rami  of  the  pubes,  and  is  there  continuous  with  the 
ligament  lining:  the  obturator  muscles,  that  the  edge  of  the 
opening  for  receiving  the  membranous  portion  of  the  urethra, 
is  produced  backward  along  the  prostate,  and  having 
ascended  as  high  as  the  arch  of  the  pubes,  it  there  splits 
into  two  laminae,  one  continuing  its  course  over  the  upper 
surface  of  the  gland  and  bladder,  the  other  lining  the  upper 
portion  of  the  levator  ani.” 

The  description  of  the  fasciae  of  the  pelvis  is  one  of  the 


* Wilson’s  Anatomy,  p.  198. 


MALE  PELVIS. 


259 


most  difficult  and  perplexing  in  the  whole  range  of  anatomy, 
and  the  proof  of  it  is,  that  almost  every  writer  on  the  sub- 
ject considers  the  labours  of  his  predecessors  imperfect, 
and  with  a very  laudable  spirit,  hoping  to  supply  the  de- 
fect, invites  the  attention  of  the  profession  to  his  improved 
views.  Not  joining  in  this  conviction,  of  the  insufficiency 
of  preceding  descriptions,  and  the  consequent  value  of  such 
as  are  offered  as  substitutes,  I feel  satisfied  in  drawing  ma- 
terials from  Mr.  Colles’s  excellent  work,  on  Surgical  Ana- 
tomy. 


PART  II 


CHAPTER  IV. 

OF  THE  ORGANS  IN  THE  FEMALE  FOR  THE  GENE- 
RATION AND  NOURISHMENT  OF  THE  INFANT. 


SECTION  I. 

Of  the  Female  Pelvis. 

The  viscera  of  the  female  pelvis  should  be  first  studied 
in  their  natural  situations  ; they  should  then  be  removed, 
and  dissected  neatly  for  more  satisfactory  examination. 
The  whole  study  may  afterwards  be  concluded  with  a side 
view,  as  in  the  male  subject. 

The  Female  Pelvis  contains  the  Urinary  Bladder  and 
Rectum,  besides  the  Organs  of  Generation.  The  first  two 
do  not  demand  particular  description  here,  as  enough  has 
been  said  concerning  them  in  the  account  of  the  male  pel- 
vis. The  Organs  of  Generation  are  situated  between  them, 
and  consist  of  the  Vulva  externally,  of  the  Vagina  in  the 
middle,  and  of  the  Uterus  with  its  appendages  internally. 

Under  the  term  Vulva  we  consider  the  most  superficial  of 
the  copulative  organs,  as  the  Mons  Veneris,  the  Labia  Ma- 


FEMALE  PELVIS. 


261 


jora  or  Externa,  the  Labia  Minora  or  Interna,  the  Clitoris, 
the  Vestibulum,  the  orifice  of  the  Urethra,  the  Fourchette, 
and  the  Fossa  Navicularis. 


OF  THE  VULVA. 

The  Mons  Veneris,  is  an  eminence  on  the  fore  part  of 
the  pubes,  which  is  produced  by  the  deposit  of  a great 
quantity  of  fat  under  the  skin.  In  very  corpulent  women 
its  size  is  occasionally  enormous.  The  skin  covering  it, 
at  the  age  of  puberty,  is  studded  with  hair,  and  under  it,  is 
a considerable  number  of  sebaceous  glands,  about  the  size 
and  shape  of  millet  seed. 

The  Labia  Externa  are  oblong  eminences,  continued 
downwards  and  backwards,  one  on  each  side,  from  the 
mons  veneris,  and  united  with  each  other  by  the  fourchette 
at  the  anterior  part  of  the  perineum.  Their  elevation  is 
produced  in  the  same  way  with  the  mons  veneris,  by  a de- 
posit of  adipose  matter  beneath  the  skin  or  integuments  ; 
they  are  somewhat  broader  and  more  prominent  above  than 
below.  On  the  side  which  is  next  to  the  thighs,  they  are 
formed  by  the  common  skin,  furnished  sparingly  with  hairs; 
but  on  the  internal  face,  the  integument  is  a mucous  mem- 
brane, being  a continuation  of  that  of  the  Vagina.  The 
skin  here  as  well  as  at  the  commencement  of  every  mu- 
cous membrane,  is  insensibly  changed  into  the  latter. 
These  bodies  have  many  sebaceous  glands  externally,  and 
mucous  orifices  internally  on  them.  In  their  interior 
structure  is  found  much  cellular  membrane,  like  that  of  the 
scrotum,  possessed  of  great  extensibility  in  order  to  favour 
the  dilatation  of  the  parts  in  parturition.  Between  them  is 
a longitudinal  rima,  about  twice  the  length  of  the  orifice  of 
the  vagina,  for  favouring  still  more  the  expulsion  of  the 
foetus.  It  is  the  Fissura  Vulvas  of  authors. 

The  Fourchette,  or  Frenulum  Vulvas,  is  situated  at 
the  posterior  commissure  of  the  labia  externa;  it  is  a nar- 
row transverse  duplicature  of  skin;  extending  across  the 
vulva  from  one  side  to  the  other,  and  is  most  frequently, 


262 


OF  THE  TRUNK. 


ruptured  at  the  first  parturition,  and  disappears.  That  por- 
tion of  the  rirna,  betwixt  it  and  the  orifice  of  the  urethra,  is 
called  by  many  anatomists,  the  Fossa  Navicularis. 

The  Clitoris,  is  a small  body  situated  between  the  up- 
per extremities  of  the  labia  externa,  on  the  lower  part  of  the 
symphysis  pubis,  and  corresponding  in  some  respects,  w ith 
the  penis  of  the  male.  It  is  furnished  with  a suspensory 
ligament,  and  curved  towmrds  the  urethra.  It  consists  of 
a body  and  of  twro  crura;  the  body  is  about  an  inch  long, 
and  the  crura  being  of  the  same  length,  arise  from  the  in- 
ternal faces  of  the  crura  of  the  pubes.  It  is  covered  by  an 
elastic  ligamentous  membrane;  has  an  internal  spongy  body 
capable  of  erection  like  the  penis,  divided  by  a septum 
pectiniforme,  and  having  a similar  supply  of  blood-vessels 
and  of  nerves.  It  has  also  an  erector  clitoridis  muscle 
lying  upon  each  crus,  and  extended  to  the  side  of  its  body, 
in  the  same  way  with  the  erector  penis. 

The  extremity  of  the  body  of  the  clitoris,  projects  into 
the  upper  part  of  the  bottom  of  the  rima  vulvae,  and  is 
called  its  Gians,  but  does  not  resemble  in  structure,  the 
glans  penis.  A kind  of  hood  is  thrown  over  it  by  a du- 
plicature  of  the  integuments  of  the  part,  which  giving 
some  resemblance  to  the  penis,  it  is  therefore  called  the 
Prepuce,  (Preputium.)  This  prepuce  is  occasionally  much 
elongated  and  its  orifice  constricted,  so  that  the  secretion 
from  its  cryptse  is  imperfectly  discharged  and  produces 
much  itching  and  irritation.  Mr.  Marjolin,  relates  the  case 
of  a Spanish  girl  of  four  years,  in  whom  he  performed  cir- 
cumcision successfully,  in  order  to  free  her  of  a very  bad 
habit  to  which  she  wrns  addicted  in  consequence  of  this 
disease. 

The  Labia  Interna,  or  Nymphac,  are  two  duplicatures 
of  the  mucous  membrane  of  the  vulva  passing  downwards, 
one  from  each  side  from  the  clitoris.  The  prepuce  of  the 
latter  terminates  on  either  side  in  the  labia ; while  the  latter 
are  continued  upwards  by  a narrow  process,  to  the  under 
surface  of  the  glans  clitoridis.  They  arise  all  along  their 
base  from  the  internal  sides  of  the  labia  majora,  are  seldom 
so  broad  naturally  as  to  project  beyond  them,  and  are  wider 


FEMALE  PELVIS. 


263 


in  the  middle  than  elsewhere ; they  terminate  insensibly 
about  half-way  down  the  orifice  of  the  vagina.  They  con- 
sist of  a duplicature  of  the  mucous  membrane  of  the  part, 
between  the  laminae  of  which,  is  placed  a vascular  cellular 
membrane  giving,  to  them  when  excited,  a somewhat 
erected  condition.  In  young  subjects  their  vascularity  com- 
municates a vermilion  tint,  which  is  lost  in  the  progress  of 
life.  They  are  supposed  to  direct  in  some  measure,  the 
stream  of  urine ; but  it  is  more  probable,  that  as  they  are 
effaced  during  parturition,  they  are  intended  to  facilitate  the 
enlargement  of  tire  vulvae. 

The  Vestibuldm,  is  a depression  of  twelve  or  fifteen 
lines  in  length,  at  the  upper  part  of  the  rima,  bounded  by 
the  clitoris  above,  and  the  nymphse  laterally ; in  it  are 
many  mucous  follicles. 

At  the  inferior  part  of  the  vestibulum,  about  an  inch  be- 
low the  glans  clitoridis,  is  the  Orifice  of  the  Urethra,  (Ori- 
ficium  Urethrae.)  It  is  generally  marked  by  a slight  rising 
or  tubercle,  which  is  easily  distinguished  by  the  sensation 
of  touch  alone ; its  margin  is  often  bounded  by  a little 
caruncle  on  each  side.  The  Urethra  itself  is  an  inch  long, 
larger  and  much  more  dilatable  than  that  of  the  male ; its 
course,  is  obliquely  downwards  and  forwards  from  the  neck 
of  the  bladder ; passing  under  the  symphysis  of  the  pubis, 
and  being  slightly  curved  from  that  cause.  It  consists  of 
two  membranes,  a lining  and  an  external  one.  The  lining 
membrane  is  a continuation  of  that  of  the  bladder  ; is  thrown 
into  several  longitudinal  folds,  and  has  many  mucous  folli- 
cles in  it.  The  external  coat  of  the  urethra  consists  of  con- 
densed laminated  cellular  membrane,  forming  a cylindrical, 
body  of  half  an  inch  in  its  transverse  diameter,  which  has 
given  the  idea  of  the  existence  of  a prostate  gland  in  the 
female.  The  lower  and  lateral  surfaces  of  this  cylinder  are 
in  contact  with  the  vagina,  forming  a protuberance  into  its 
cavity,  and  the  upper  surface  is  firmly  connected  to  the  tri- 
angular ligament  of  the  pubes. 


OF  THE  VAGINA. 

The  Vagina,  is  the  intermediate  part  of  the  sexual  organs, 
and  extends  from  the  vulva  to  the  Uterus,  being  placed  be- 


264 


OF  THE  TRUNK. 


tween  the  Bladder  and  Rectum,  and  compressed  anteriorly 
and  posteriorly  by  them.  In  virgins,  its  external  extremity 
is  contracted  into  a smaller  canal  than  the  internal,  and  be- 
sides this,  is  closed  by  a membrane  called  the  Hymen. 

The  Hymen,  situated  just  within  the  orifice  of  the  vagina, 
is  a partial  septum  formed  by  a reflection  or  duplicature  of 
its  lining  membrane ; it  varies  very  much  in  shape,  breadth 
and  thickness.  Most  commonly  it  is  crescentic  and  fixed 
to  the  inferior  part  of  the  vaginal  orifice  by  its  convex  edge, 
the  horns  being  upwards  ; in  other  cases  it  is  to  the  side. 
Sometimes  it  is  a circular  membrane,  having  a hole  in  the 
centre  for  the  passing  of  mucus  and  menstrual  blood.  Be- 
ing simply  a duplicature  cf  the  mucous  membrane,  it  is 
generally  so  weak  that  it  is  ruptured  at  the  first  act  of  copu- 
lation, or  by  slight  causes  during  infancy,  but  occasionally 
it  is  so  resisting,  that  it  has  required  artificial  division  to 
make  it  yield  even  to  the  expulsive  efforts  of  the  uterus  in 
parturition.  Its  presence  then,  is  not  invariably  a proof  of 
virginity,  nor  is  its  absence  a proof  of  improper  indulgence. 

The  Vagina,  is  a membranous  canal  of  from  four  to  six 
inches  in  length,  differing  according  to  age  and  pregnancy, 
being  much  shorter  in  women  who  have  borne  children, 
than  in  virgins.  Its  shape  varies  somewhat;  near  the  vulva, 
its  greatest  diameter  is  vertical,  but  behind  near  the  uterus, 
the  greatest  diameter  is  transverse.  Its  anterior  and  poste- 
rior surfaces  are  in  contact  from  the  circumstances  just  men- 
tioned, of  pressure  between  the  bladder  and  the  rectum.  It 
is  shorter  before  than  behind,  corresponding  in  this  respect 
with  the  pelvis  by  which  it  is  influenced,  and  also  in  conse- 
quence of  being  attached  to  the  uterus,  higher  up  on  the 
sacral,  than  on  the  pubic  side. 

It  consists  of  two  coats,  a fibrous  and  elastic  one  ex- 
ternally, and  a mucous  one  internally.  The  first  is  of  a 
reddish  colour,  and  seems  to  be  formed  of  condensed  cel- 
lular membrane,  its  fibres  not  passing  in  any  determinate 
direction.  Many  blood-vessels  are  found  in  its  structure, 
and  it  has  an  abundance  of  large  venous  sinuses  surround- 
ing it. 

On  the  anterior  part  of  this  coat  externally,  there  is  an 
erectile  tissue,  (Corpus  Spongiosum  Vaginae,)  about  one 


FEMALE  PELVIS. 


265 


inch  broad  and  a line  or  two  thick,  which  is  placed  on  its 
superior  and  lateral  surfaces,  covering  about  one-half,  or 
two-thirds  of  the  whole  circumference  of  the  vagina.  The 
structure  of  this  body  closely  resembles  that  of  the  corpus 
spongiosum  urethra,  and  from  being  very  vascular,  is  sub- 
ject to  distention  in  its  cells  during  sexual  excitement.  It 
is  frequently  called  the  Plexus  Retiformis,  and  is  covered 
by  the  sphincter  vaginse  muscle. 

The  Sphincter  Vaginas,  arises  from  the  body  of  the  clitoris 
and  the  crus  pubis ; forms  an  expanse  of  an  inch  and  a 
quarter,  around  the  anterior  end  of  the  vagina;  and  is  in- 
serted into  a dense  whitish  substance  in  the  centre  of  the 
perineum,  common  to  it,  the  sphincter  ani  and  the  transversi 
perinei  muscles. 

The  transverse  perinei  muscles  exist  in  the  female,  and 
have  the  same  circumstances  of  origin  and  insertion,  but 
are  not  so  strong  as  in  the  male.  ; 

Anterior  to  the  corpus  spongiosum  on  each  side  of  the 
vagina,  near  its  middle,  is  frequently  a mucous  gland  about 
the  size  of  a garden  pea,  which  corresponds  with  Cowper’s 
gland  in  the  male. 

To  bring  into  view  satisfactorily  the  internal  membrane 
of  the  vagina,  the  canal  should  be  slit  up  laterally,  from  its 
external  orifice  to  the  uterus;  this  membrane  being  mucous, 
will  then  be  observed  as  continuous  with  the  mucous  mem- 
branes of  the  vulva  and  uterus.  Near  the  vulva  it  is  of  a 
vermilion  tinge,  but  near  the  uterus  it  is  grayish,  with  several 
dark  spots,  giving  it  a marbled  appearance  ; its  thickness, 
diminishes  as  it  recedes  from  the  external  orifice. 

In  females  in  whom  the  hymen  is  ruptured,  its  remains 
consist  in  from  two  to  six  small  tubercles,  the  Carunculas 
Myrtiformes.  On  its  anterior  or  pubic  wall,  the  internal  sur- 
face of  the  vagina  is  divided  longitudinally  by  a ridge, 
commencing  in  a sort  of  tubercle,  at  the  anterior  orifice  of 
the  vagina,  just  under  the  meatus  urinarius;  this  ridge  pro- 
ceeds backwards,  but  becomes  indistinct  in  approaching  the 
uterus ; from  it  on  each  side  proceed  transverse  ridges  or 
folds  of  the  mucous  membrane,  which  are  particularly  nu- 
merous and  prominent  before,  but  become  indistinct  and 
irregular  near  the  uterus.  The  inferior  side  of  the  vagina, 
has  the  same  sort  of  arrangement  as  the  superior,  only  not 
so  well  marked. 


266 


OF  THE  TRUNK. 


By  cleaning  the  vagina,  and  suspending  it  in  water,  an 
abundance  of  mucous  cryptae  may  be  observed  on  its  whole 
internal  surface,  which  by  an  increased  discharge,  produce 
leucorrhoea. 

The  peritoneum,  in  descending  from  the  uterus  ante- 
riorly, touches  the  top  of  the  vagina  for  a little  distance, 
and  is  then  reflected  to  the  bladder,  but  posteriorly,  nearly 
the  upper  half  of  the  vagina  has  a peritoneal  coat,  before 
this  membrane  is  reflected  to  the  rectum.  The  attachment 
of  the  vagina  to  the  bladder,  is  strong  and  close  just  about 
the  urethra,  but  its  connexion  to  the  rectum,  is  by  rather 
loose  cellular  membrane. 


THE  UTERUS  AND  ITS  APPENDAGES,  THE  FALLO- 
PIAN TUBES  AND  OVARIA. 

The  Uterus  is  a compressed  pyriform  body  with  a cavity 
in  its  centre,  placed  between  the  bladder  and  rectum,  has 
the  small  intestines  above  it,  and  the  vagina  below.  Unim- 
pregnated, it  is  two  inches  and  a half  long,  and  an  inch  and 
a half  wide  at  its  broadest  part,  about  one  inch  thick  and 
much  flatter  on  its  anterior  than  on  the  posterior  surface. 
It  is  divided  by  anatomists  into  Fundus,  Body*  and  Neck. 
The  fundus  is  the  superior  convex  edge,  between  the  orifices 
of  the  Fallopian  Tubes;  the  neck,  the  narrow  cylindrical 
part  about  an  inch  long  below,  and  the  body,  the  portion 
between  these  two. 

The  Uterus  is  maintained  in  its  situation  in  the  centre  oi 
the  pelvis,  by  the  reflections  of  the  peritoneum,  which  are 
called  ligaments.  The  peritoneum,  after  covering  the  uterus 
completely,  is  reflected  anteriorly  upon  the  vagina,  and  at 
each  side  of  this  reflection  is  a fugitive  duplicature  of  the 
membrane,  denominated  the  Anterior  Ligament,  which  goes 
to  the  bladder.  The  peritoneum  in  passing  from  the  back 
part  of  the  uterus  to  the  vagina  and  subsequently  to  the 
rectum,  has  on  each  side  of  this  reflection  also  a duplica- 
ture, which  constitutes  the  Posterior  Ligament.  The  peri- 
toneum is  also  reflected  from  the  whole  length  of  each  side 
of  the  uterus,  to  the  corresponding  part  of  the  cavity  of  the 
pelvis ; these  reflections  are  termed  the  Lateral  or  the 
Broad  Ligaments.  The  peritoneum  coA'ers  much  more  of 
the  vagina  posteriorly',  than  it  does  anteriorly. 


FEMALE  PELVIS. 


267 


The  Uterus,  Fallopian  Tubes,  Ovaries  and  a Part  of  the  Vagina 
of  a Female  of  Sixteen  Years.  On  one  Side  the  Tube  and 
Ovary  is  divided  Vertically;  the  other  Side  is  untouched. 
The  Anterior  Portion  of  the  Uterus  and  Vagina  have  also 

BEEN  REMOVED. 

Fig.  52. 


1.  Fundus  of  the  Uterus. 

2.  Thickness  of  its  Parieties  Anteriorly. 

3.  External  Surface  of  the  Uterus. 

4.  Section  of  the  Neck  of  the  Uterus. 

5.  Section  of  the  Anterior  Lip. 

6.  Its  Posterior  Lip,  untouched. 

7.  Cavity  of  the  Uterus. 

8.  Cavity  of  its  Neck. 

9.  Thickness  of  the  Walls  of  the  Vagina. 

10.  Its  Cavity  and  Posterior  Parietes. 

11.  Openings  of  Fallopian  Tubes  into  the  Uterus. 

12.  Cavity  of  the  Left  Tube. 

13.  Its  Pavilion. 

14.  Corpus  Fimbriatum. 

15.  Its  Union  with  the  Ovary. 

16.  Left  Ovary  vertically  divided. 

17.  The  Vesicles  in  its  Tissue. 

18.  Ligament  of  the  Ovary. 

19.  Right  Fallopian  Tube,  untouched. 

20.  Its  Corpus  Fimbriatum. 

21.  Right  Ovary. 

22.  The  Broad  Ligament. 

These  Broad  Ligaments,  with  the  uterus,  form  a trans- 
verse septum  in  the  middle  of  the  pelvis.  At  the  superior 
edge  of  this  septum,  on  each  side,  is  the  Fallopian  Tube, 
ind  on  the  posterior  face  of  the  septum,  below  the  edge, 
ind  about  an  inch  or  a little  more  from  the  uterus,  on  each 


268 


OF  THE  TRUNK. 


side,  is  an  Ovarium.  The  peritoneum  adheres  to  the  uteru 
by  a cellular  tissue,  which  is  somewhat  loose  and  can  b< 
easily  dissected  from  it. 

Besides  the  ligaments  mentioned,  the  uterus  has  twc 
more,  one  on  each  side,  called  the  Round  Ligaments 
They  arise  from  the  side  of  its  body,  between  the  duplica- 
tures  of  the  broad  ligaments,  and  pass  under  the  perito- 
neum to  the  abdominal  ring,  through  which  they  penetrate, 
and  are  lost  upon  the  fat  of  the  mons  veneris  and  of  tk 
labia  majora.  They  are  of  a condensed  cellular  or  fibrous 
structure,  and  have  many  blood-vessels  in  them. 

The  neck  of  the  uterus  is  enclosed  by  the  cavity  of  the 
vagina,  in  such  a wTay  that  it  projects  into  the  latter.  Id 
the  centre  of  this  projection  is  the  Orifice  of  the  Uterus. 
(Os  Tineas,)  which  is  not  perfectly  cylindrical,  but  somewhat 
flattened  or  oval ; this  orifice  is  bounded  before  and  behind 
by  the  lips  or  projections  of  the  neck,  which  are  transverse. 
The  posterior  lip  is  somewhat  thinner  than  the  anterior,  but 
in  consequence  of  the  insertion  of  the  vagina  on  that  side 
being  higher  up,  it  projects  more  into  the  vagina,  and  is 
easily  distinguished  by  the  finger. 

Behind  the  os  tincse  is  the  Cavity  of  the  Neck,  which  is 
a paraboloid  cylinder,  larger  in  the  middle  than  at  either 
end ; its  termination  forwards  is  about  the  size  of  a small 
writing  quill,  the  posterior  extremity  is  somewhat  larger. 
In  the  middle  of  this  cavity,  before  and  behind,  longitudi- 
nally, is  a line  formed  by  an  elevation  of  the  lining  mem- 
brane, and  on  each  side  of  this  line,  transversely  or 
obliquely,  there  are  others  presenting  an  arborescent  ar- 
rangement. This  is  the  Arbor  Vitae.  In  the  interstices  of 
the  transverse  lines,  there  are  small  mucous  glands  called 
Ovula  Nabothi,  in  consequence  of  this,  anatomists  mistaking 
them  for  eggs. 

The  cavity  of  the  body  of  the  uterus  is  triangular,  the 
sides  of  the  triangle  being  curved  inwards,  so  as  to  present 
their  convexities  to  its  cavity.  The  cavity  is  nearly  equi- 
lateral, and  has  its  anterior  and  posterior  surfaces  in  con- 
tact; the  angle  belowT  is  continued  into  the  cavity  of  the 
neck,  and  the  angles  above  are  continuous  with  the  fallo- 
pian tubes,  being  extended  very  far  through  the  parietes  ci 
the  uterus,  in  order  to  meet  them.  This  cavity  is  some- 


FEMALE  PELVIS. 


269 


imes  divided  into  two  symmetrical  halves,  by  an  elevated 
ine  on  its  anterior  and  posterior  surface,  running  from  above 
ownwards.  It  is  said,  that  in  some  cases,  they  have  had 
complete  partition. 

The  internal  membrane  of  the  uterus  is  a continuation  of 
aat  of  the  vagina,  and  adheres  so  closely  that  its  existence 
as  been  doubted.  It  has  very  little  thickness,  is  extremely 
mooth,  and  presents  villosities  so  fine,  that  they  are  seen 
/ith  difficulty  by  the  naked  eye.  It  is  of  a light  pink 
olour,  which  changes  into  a deeper  vermilion  a few  days- 
efore,  and  during  menstruation.  It  abounds  with  mucous 
ryptae  and  exhalent  orifices. 

The  texture  of  the  uterus  is  essentially  fibrous,  and  of  a 
'hite  colour  tinged  with  red,  from  having  a great  number 
f blood-vessels  in  its  composition.  The  fibres  have  no 
eterminate  course,  but  are  blended  and  interwoven  in 
very  direction.  Its  muscularity  is  not  apparent  in  the 
nimpregnated  state. 

The  Fallopian  Tubes,  (Tubas  Fallopianae,)  are  two 
tembranous  canals  fixed,  as  mentioned,  in  the  upper  edges 
jf  the  broad  ligaments.  They  are  about  four  inches  long, 
pmewhat  serpentine,  and  extend  from  the  upper  angles  of 
le  uterine  cavity  to  the  sides  of  the  pelvis.  At  their  ute- 
ne  extremities  these  tubes  scarcely  admit  a hog’s  bristle, 
.it  as  they  proceed  externally,  about  half-way  of  their 
ngth,  they  begin  to  increase,  and  continue  to  do  so  very 
pidly  almost  to  their  termination,  where  they  become 
unewhat  contracted,  and  immediately  afterwards  enlarge, 
end  by  an  oblique  trumpet-shaped  mouth,  singularly 
inged,  called  Morsus  Diaboli,  or  Corpus  Fimbriatum. 
his  latter  part  of  the  tube  is  loose  and  pendulous,  over- 
inging  the  ovarium  on  the  back  part  of  the  broad  liga- 
ent. 

The  Fallopian  Tube  seems  to  be  a continuation  of  the 
ructure  of  the  uterus,  having  a fibrous  membrane  ex- 
rnally,  and  an  internal  mucous  one;  the  latter  is  princi- 
dly  concerned  in  forming  its  large  extremity,  and  is 
ndered  erectile  in  sexual  excitement,  probably  by  its 
'eat  vascularity. 

The  Ovaries,  (Ovaria,  Testes  Muliebres,)  are  situated 


270 


OF  THE  TRUNK. 


one  on  each  side  of  the  uterus,  and  on  the  posterior  face  o 
the  broad  ligament  enclosed  in  a duplicature  of  it.  They  an 
compressed  ovoids  about  half  the  size  of  the  testicle,  of  ; 
very  light  pink  colour;  are  connected  to  the  uterus  bv  ; 
small,  vascular,  and  fibrous  cord,  called  Ligament  of  th* 
Ovary,  which  is  inserted  into  the  uterus  just  below  the  fal- 
lopian tube.  The  external  end  of  the  ovary,  has  one  of  th* 
processes  of  the  corpus  fimbriatum  or  morsus  diaboli  ad 
hering  to  it. 

The  surface  of  the  ovary  is  generally  found  somewha 
uneven,  from  a number  of  marks  resembling  cicatrices.  I 
has  a complete  peritoneal  coat,  and  within  this  is  anothe: 
of  a strong,  compact,  fibrous  character,  sending  many  pro- 
cesses internally,  and  which  is  the  Tunica  Albuginea. 

The  structure  of  this  body  is  as  follows:  When  the 
ovary  of  a healthy  female  (different  from  those  usually  fount 
in  our  dissecting-rooms,  who  from  disease  or  excessivt 
sexual  indulgence  do  not  present  the  organ  in  its  norma 
condition)  is  examined  by  cutting  through  the  Tunica  Al- 
buginea, the  organ  is  found  to  consist  of  a spongy  fibiou: 
tissue,  abundantly  furnished  with  blood-vessels  from  the 
spermatic  artery  and  vein.  In  this  spongy  tissue,  callec 
Stroma,  are  from  fifteen  to  twenty  or  more  spherical  vesicles 
(Ovula  Graafiana,)  according  to  the  commonly  receiver 
opinion.  They  vary  in  size  from  half  a line  to  three  line- 
in  diameter ; the  larger  ones  are  nearer  the  surface,  anc 
from  having  caused  the  absorption  of  the  tunica  albuginea, 
may  sometimes  be  seen  through  the  peritoneal  coat  anc 
give  to  the  surface  of  the  ovarium  an  embossed  condition. 
These  vesicles  contain  a transparent  fluid,  having  within  ii 
the  rudiments  of  the  embryo.  As  the  vesicles  are  evolved, 
they  advance  from  the  centre  to  the  circumference.  Theii 
parietes  are  thin,  transparent,  and  have,  creeping  through 
them,  minute  arterial  and  venous  ramifications.  The  bed 
of  the  ovarium,  in  which  a vesicle  reposes,  is  called  the 
Calyx. 

To  Von  Baer  belongs  the  merit  of  discerning  first  the 
Ovulum  of  man  and  mammalia,  in  the  Graafian  Vesicle. 
This  ovulum  occupies  but  a very  small  part  of  the  cavity 
of  the  graafian  vesicle,  the  remainder  being  filled  with  ar 
albuminous  fluid,  in  which  microscopic  granules  float.  By 


FEMALE  MAMMiE. 


271 


discharging  the  fluid  from  a graafian  vesicle,  the  ovulum 
can,  with  a simple  lens,  be  detected  in  a globular  form  and 
floating  in  this  fluid.  A very  remarkable  point  mentioned 
by  Carus,  is,  that  all  the  essential  parts  of  the  ovulum  can 
be  detected  in  the  ovary  of  the  mature  human  embryo,  or  in 
that  of  mammiferous  animals;  hence  the  preparation  for 
new  generation  seems  to  begin  at  a very  early  period  of 
life.  Upon  the  escape  of  the  contents  of  a graafian  vesicle, 
the  latter  is  first  filled  with  coagulating  lymph  or  blood, 
which  being  after  a time,  absorbed,  the  vesicle  collapses 
and  shrivels,  and  the  stigma,  then  remains  permanently  as  a 
stellated  cicatrix  (Corpus  Luteum.)  Sometimes  the  entire 
surface  of  the  ovarium  is  marked  with  them. 

The  Bladder  and  Rectum,  with  unimportant  exceptions, 
are  the  same  in  both  sexes.  The  arteries  of  the  viscera  of 
the  pelvis,  in  both  cases,  are  derived  from  the  internal 
iliacs. 

The  Levator  Ani,  Coccygeus,  and  Sphincter  Ani  muscles 
have  the  same  arrangement  as  in  males. 

The  Fasciae  connecting  the  bladder  to  the  sides  of  the 
pelvis,  and  the  triangular  ligament  of  the  urethra,  also  exist. 


SECTION  II. 

Of  the  Female  Mammae. 

The  Mammae  are  two  glandular  bodies,  situated  over  the 
thorax,  upon  the  great  pectoral  muscles,  between  the  arm- 
pits  and  the  sternum,  and  intended,  in  the  female,  for  the 
secretion  of  milk.  They  are  hemispherical,  and  vary  much 
in  size,  according  to  the  age  of  the  person  and  the  state  of 
the  uterine  system. 

The  skin  which  covers  the  mamma  is  very  fine  and  thin, 
and  through  it  may  be  seen  readily,  the  veins  which  creep 
beneath  it.  It  is  very  extensible,  but  does  not  possess 
much  power  of  contraction.  Beneath  the  skin,  between  it 
and  the  surface  of  tha  gland,  there  is  an  abundance  of  cel- 


272 


OF  THE  TRUNK. 


lular  substance  intermixed  with  lobules  of  fat,  which 
together  make  a greater  volume  of  matter  than  the  gland 
itself.  The  exterior  surface  of  the  gland  is  rendered  verv 
unequal,  by  being  penetrated  at  different  depths  by  this 
cellular  and  adipose  matter,  and  its  lobules  are  divided  by 
irregular  fossae  from  each  other.  The  substance  of  the 
gland  is  united  to  the  pectoralis  major  muscle,  by  a loose 
cellular  tissue,  'which  contains  very  little  fat. 

The  mamma  is  composed  of  Lobes  of  different  sizes, 
united  together  in  such  a way  by  cellular  texture,  that  they 
cannot  be  separated  without  injury  to  them.  These  lobes 
are  composed  of  Lobuli,  which  again  are  formed  by  granuli 
of  a white  colour  tinged  with  red.  These  granuli  are  the 
size  of  a millet-seed,  and  according  to  some  anatomists, 
consist  of  vesicles  which  are  very  apparent  by  the  aid  of  a 
microscope,  in  a gland  filled  with  milk.* 

The  roots  of  the  excretory  vessels,  or  the  lactiferous 
ducts,  arise  from  these  grains;  they  are  extremely  fine,  and 
unite  after  a short  course,  to  contiguous  ones,  by  successive 
accumulations  resembling  the  branches  of  a tree:  large 
trunks  are  finally  formed,  which  terminate  in  still  larger 
placed  in  the  centre  of  the  gland  near  the  base  of  the  nip- 
ple. All  the  lactiferous  ducts  converge  from  the  circum- 
ference of  the  gland,  to  its  centre;  their  course  however,  is 
very  tortuous;  their  coats  are  thin,  semi-transparent,  and 
very  capable  of  extension  and  contraction.  They  are 
numerous,  and  from  two  to  four  of  them  unite  into  a common 
trunk,  called  Lactiferous  Sinus,  which  is  only  a few  lines 
long,  and  placed  near  the  base  of  the  nipple.  These 
sinuses  are  about  fifteen  in  number,  are  of  different  diameters, 
the  largest  about  three  lines  wide,  but  others  scarcely  exceed 
the  diameter  of  the  lactiferous  tubes.  From  the  extremity 
of  each  sinus  arises  a small  excretory  duct,  which  conducts 
the  milk  to  the  summit  of  the  nipple.  This  duct  is  of  a 
conical  shape,  sometimes  dilated  in  its  middle,  and  is 
curved  and  folded  upon  itself  when  the  nipple  is  not  in  a 
state  of  erection,  by  which  means  the  milk  is  prevented 
from  flowing  through  it.  The  sinuses,  and  these  ducts, 
are  united  together  by  condensed  cellular  membrane;  they 


* See  Marjolin,  vol.  ii.  p.  295. 


FEMALE  MAMMiE. 


273 


have  no  valves,  neither  have  the  lactiferous  tubes  in  any 
part  of  their  course. 

An  opinion  was  entertained  by  Haller,  and  by  many  other 
anatomists  after  him,  that  some  of  the  lactiferous  ducts 
originated  in  the  surrounding  cellular  texture  ; this  has  been 
refuted  by  the  researches  of  Cuboli.  The  excretory  ducts 
of  the  different  lobes,  are  for  the  most  part  kept  distinct 
from  each  other,  there  being  no  anastomoses  between  them; 
hence  it  happens  that  in  the  injection  of  the  gland  with 
mercury,  it  is  necessary  to  inject  each  milk  duct  of  the 
nipple  separately.  Some  anatomists  have  thought  that 
there  is  a direct  communication  between  the  roots  of  the 
lactiferous  tubes,  and  the  arteries,  veins  and  lymphatics. 
Mascagni,  after  a very  successful  injection  of  the  gland,  in 
which  he  filled  its  vesicles  with  quicksilver,  not  meeting 
with  such  an  occurrence,  was  induced  to  think  that  when 
such  communication  did  happen,  it  was  by  rupture. 

The  Areola  in  virgins,  is  a rose  coloured  circle,  which 
surrounds  the  base  of  the  papilla  or  nipple.  In  women 
who  have  borne  children,  or  in  those  whose  age  is  advanced, 
it  becomes  of  a dark  brown.  The  skin  of  the  areola  is  ex- 
tremely delicate,  and  on  its  surface,  particularly  in  pregnant 
or  nursing  females,  there  are  from  four  to  ten  tubercles, 
which  sometimes  form  a regular  circle  near  its  circum- 
ference, and  in  other  subjects  are  irregularly  distributed. 
Each  of  these  tubercles,  has  near  its  summit,  three  or  four 
foramina,  which  are  the  orifices  of  the  excretory  ducts  of  a 
little  gland  forming  the  tubercle.  From  this  gland  is 
secreted,  according  to  some,  an  unctuous  fluid  for  protect- 
ing the  surface  of  the  areola,  while  others  consider  it  only 
as  lactescent.  The  areola  consists  of  a spongy  tissue, 
beneath  which  there  is  no  fat ; it  is  susceptible  of  distention 
during  lactation,  or  from  sexual  excitement. 

The  Papilla  or  Nipple,  is  the  truncated  cone  in  the 
centre  of  the  mamma,  of  the  same  colour  with  the  areola, 
and  surrounded  by  it.  The  milk  ducts  all  terminate  on  its 
upper  end.  It  is  collapsed  and  in  a very  pliable  state  for 
the  most  part,  but  when  excited  it  swells,  becomes  more 
prominent,  and  of  a deeper  colour.  Its  skin  is  rough,  and 
provided  with  numerous  and  very  small  papillae.  Its  in- 
18 


I 


274 


OF  THE  TRUNK. 


ternal  structure  consists  merely  of  the  milk  ducts,  united  by 
condensed  cellular  membrane. 


Fig.  53 

A Preparation  of  the  Lacti- 
ferous Tubes,  during  Lacta- 
tion. 

1.2.  Top  and  Base  of  the  Nipple. 

3.  Lactiferous  Tubes  in  the  Natural 
State. 

4.  Two  in  the  Nipple  which  are  is- 
jected. 

5.  These  Tubes  dilated  and  forming 
a kind  of  Sinus  at  the  Base  of  the 
Nipple. 

6.  The  Roots  of  the  Lactiferous 
Ducts. 

7.  Lobules  of  the  Gland. 

8.  The  Orifices  of  the  prepared 
Tubes. 

The  mamma  is  supplied  with  blood  from  the  external 
thoracic,  intercostal,  and  internal  mammary  arteries.  Its 
veins  attend  their  respective  arteries.  The  nerves  come 
from  the  brachial  plexus  and  the  intercostals.  Its  lym- 
phatics run  into  the  internal  mammary  and  axillary  trunks. 


CHAPTER  V. 


OF  THE  NERVES  AND  VESSELS  OF  THE  TRUNK. 

I have  thought  it  better  to  give  a separate  considera- 
tion to  the  nerves  and  vessels  of  the  trunk,  by  not  involving 
them  with  the  viscera,  because  it  is  the  easiest  manner  of 
studying  them,  and  such  as  the  student  most  frequently 
adopts  when  left  to  his  own  discretion  ; which  alone,  is  in 
some  measure  a proof,  of  its  being  the  most  natural  and 
agreeable  method.  The  arteries  should  be  filled  with 
either  of  the  coarse  injections  ; this  is  less  important  for  the 
veins,  and  may  be  dispensed  with. 


SECTION  1. 

Of  the  JYerves. 

The  Phrenic  Nerve  arises  from  the  anterior  fasciculus  of 
the  second  and  third  cervical,  and  is  assisted  generally,  by 
two  or  three  filaments  from  the  upper  part  of  the  brachial 
plexus.  It  descends  vertically  on  the  humeral  side  of  the 


276 


OF  THE  TRUNK. 


internal  jugular  vein,  but  removed  a considerable  distance 
from  it,  and  is  attached  by  cellular  substance,  to  the  front 
of  the  scalenus  anticus  muscle.  Getting  in  its  descent  to 
the  internal  margin  of  the  latter,  it  passes  into  the  thorax 
from  the  neck,  by  the  side  of  the  descending  cava  on 
the  right,  between  it  and  the  pleura  ; it  then  goes  along 
the  superior  mediastinum  to  the  pericardium,  to  the  side 
of  which  it  adheres  in  front  of  the  root  of  the  lungs, 
being  between  the  pericardium,  and  the  corresponding 
portion  of  the  pleura ; it  finally  reaches  the  diaphragm 
to  which  it  is  distributed.  On  the  left  side,  with  the  ex- 
ception of  the  descending  cava,  and  of  its  being  turned 
somewhat  out  of  its  way  by  the  projection  of  the  point  of 
the  heart,  its  course  is  the  same.* 

The  nerve  getting  to  the  diaphragm,  is  spread  out  in  a 
radiated  direction  by  branches  which  interchange  filaments. 
Some  of  the  branches  are  distributed  in  its  thickness,  and 
upon  its  concave  surface.  On  the  right  side,  some  of  these 
branches  pass  through  the  opening  for  the  Ascending  Vena 
Cava,  and  thus  getting  into  the  abdomen,  anastomose  with 
the  solar  plexus  and  with  the  pneumogastric  nerve.  The 
phrenic  nerve  of  the  left  side,  is  nearer  to  the  root  of  the 
lung,  than  that  of  the  right,  in  consequence  of  the  projection 
of  the  apex  of  the  heart  on  that  side.  Its  distribution,  in 
other  respects,  does  not  present  any  remarkable  difference 
from  the  other.  It  sends  some  filaments  to  the  lower  part 
of  the  oesophagus. 

The  Par  Vagum,  before  it  gives  off  the  recurrent  nerve, 
sends  off  one  or  more  twigs  to  join  the  cardiac  plexus;  it 
also  contributes  to  the  same,  when  the  recurrent  nerve  is 
separating  from  it.  From  a little  below  this  place,  the  par 
vagum  sends  off  the  Anterior  Pulmonary  Plexus,  derived 
principally  from  two  branches,  a large  and  a small  one, 
which  subdivide  and  go  in  front  of  the  trachea  and  of  the 
root  of  the  lungs.  The  ramifications  of  this  plexus,  follow 
generally  the  bronchia  and  blood-vessels,  into  the  sub- 
stance of  the  lungs,  but  some  of  them  are  turned  into  the 
cardiac  plexus. 

The  trunk  of  the  par  vagum  proceeds  then,  on  the  out- 
side of  the  bronchia,  and  a little  lower  down,  behind  it, 
passes  in  contact  with  the  posterior  surface  of  the  root  of 


* For  a farther  account  of  this  nerve  see  the  Neck. 


NERVES. 


277 


the  lungs.  Here  it  gives  off  successively  five  or  six 
branches  of  different  magnitudes,  which  leave  the  main 
trunk  almost  at  right  angles,  divide  and  subdivide,  and 
following  the  bronchia,  are  spent  upon  its  ultimate  ramifi- 
cations in  the  lungs.  These  branches  constitute  the  Pos- 
terior Pulmonary  Plexus. 

After  the  posterior  pulmonary  plexus  is  given  off,  the 
par  vagum  remaining  still  considerable,  attaches  itself  to 
the  oesophagus,  being  split  into  three  or  four  fasciculi  which 
spread  out  and  unite  again.  From  the  crossing  of  the 
bronchia  to  the  joining  with  the  oesophagus,  a great  many 
small  ramifications  are  sent  to  the  oesophagus,  forming  a 
plexus  on  it;  some  are  sent  also  to  the  aorta. 

The  Left  Par  Vagum  is  situated  on  the  anterior  lateral 
surface  of  the  oesophagus,  and  the  Right  Par  Vagum  on  the 
posterior  lateral  surface,  each,  however,  adhering  to  its 
own  side,  and  forming  a plexus  which  partially  surrounds 
the  (Esophagus.  They  pass  through  the  Foramen  CEsopha- 
geum  of  the  diaphragm,  along  with  the  oesophagus,  and 
their  fibres  are  re-assembled  into  more  considerable  trunks. 
The  left  par  vagum,  is  distributed  along  the  lesser  curvature 
of  the  stomach,  between  the  cardia  and  the  pylorus,  to  the 
anterior  side  of  the  stomach,  to  the  lesser  omentum,  and 
some  of  its  branches  extend  to  the  left  hepatic  and  the 
solar  plexus.  The  right  par  vagum  surrounds  with  its 
branches,  the  cardiac  orifice  of  the  stomach,  supplies  the 
under  side  and  great  curvature,  sends  branches  along  the 
gastric  artery  to  unite  with  the  hepatic  and  splenic  plexuses, 
and  one  trunk  to  the  solar  plexus. 

The  Sympathetic,  or  Intercostal  Nerve,  is  principally 
employed  in  the  thorax  in  supplying  the  heart.  With  this 
view,  it  sends  to  it  three  nerves  on  the  right  side,  and  two 
on  the  left,  called  Cardiac. 

The  Right  Superior  Cardiac,  is  derived  by  several  fila- 
ments from  the  upper  cervical  ganglion,  joined  by  some 
from  the  superior  laryngeal  nerve.  They  unite  into  one 
trunk,  which  accompanies  the  common  carotid  on  its  ex- 
ternal surface,  as  far  as  the  middle  cervical  ganglion;  here 
the  trunk  divides,  one  part  of  it,  and  the  smaller,  running 
along  the  carotid  and  arteria  innominata  to  the  aorta, 
the  other  joining  a plexus  just  below  the  middle  cervical 
ganglion. 


278 


OF  THE  TRUNK. 


A View  of  the  distribution  of  the  Glosso-Pharyngeal,  Pneumo- 
Gastric  and  Spinal  Accessory  Nerves,  or  the  Eighth  Pair. 

Fig.  54. 


1.  The  Inferior  Maxillary  Nerve. 

2.  The  Gustatory  Nerve. 

3.  The  Choroda-Tympani. 

4.  The  Auricular  Nerve. 

5.  Its  communication  with  the  Portio-Dura. 

6.  The  Facial  Nerve  coming  out  of  the  Stylo-Mastoid  Foramen. 


NERVES. 


279 


7.  The  Glosso-Pharyngeal  Nerve. 

8.  Branches  to  the  Stylo-Pharyngeus  Muscle. 

9.  The  Pharyngeal  Branch  of  the  Pneumo-Gastric  Nerve  descending 

to  form  the  Pharyngeal  Plexus. 

10.  Branches  of  the  Glosso-Pharyngeal  to  the  Pharyngeal  Plexus. 

11.  The  Pneumo-Gastric  Nerve. 

12.  The  Pharyngeal  Plexus. 

13.  The  Superior  Laryngeal  Branch. 

14.  Branches  to  the  Pharyngeal  Plexus. 

15.15.  Communication  of  the  Superior  and  Inferior  Laryngeal  Nerves. 

16.  Cardiac  Branches. 

17.  Cardiac  Branches  from  the  Right  Pneumo-Gastric  Nerve. 

18.  The  Left  Cardiac  Ganglion  and  Plexus. 

19.  The  Recurrent  or  Inferior  Laryngeal  Nerve. 

20.  Branches  sent  from  the  curve  of  the  Recurrent  Nerve  to  the  Pulmo- 

nary Plexus. 

21.  The  Anterior  Pulmonary  Plexus. 

22.22.  The  Oesophageal  Plexus. 

The  Middle  or  Great  Cardiac  Nerve,  arises  from  the 
inferior  part  of  the  middle  cervical  ganglion,  passes  alongthe 
external  surface  of  the  carotid  artery,  and  crosses  the  sub- 
clavian in  front,  just  at  its  root,  it  then  goes  along  with  the 
arteria  innominata  for  a little  distance,  and  terminates  in 
the  upper  part  of  the  cardiac  plexus. 

The  Third  or  Inferior  Cardiac  Nerve  comes  from  the 
lower  cervical  ganglion,  by  several  filaments,  which  unite 
into  a smaller  number  to  form  a plexus,  and  which  de- 
scends behind  the  subclavian  artery,  between  the  innomi- 
nata and  trachea,  to  the  posterior  part  of  the  arch  of  the  aorta. 

On  the  left  side,  the  Upper  Cardiac  nerve  originates 
In  the  same  way  as  on  the  right,  from  the  first  cervical 
ganglion  and  upper  laryngeal*;  attending  the  common 
carotid,  it  is  increased  lay  fibrillse  from  the  sympathetic,  be- 
tween the  first  and  second  ganglia.  In  the  upper  part  of 
the  thorax,  this  nerve  is  between  the  carotid  and  subclavian 
arteries,  and  at  their  roots,  some  of  its  branches  go  in  front 
of  the  aorta  and  others  behind  it.  The  second  cardiac 
nerve  of  the  left  side,  is  derived  from  the  middle  and  lower 
cervical  ganglia  of  the  sympathetic.  Several  branches 
being  despatched  by  the  two  ganglia,  they  form  a plexus 
which  surrounds  the  subclavian,  at  the  origin  of  the  inferior- 
thyroid  and  transversalis  colli  arteries.  From  this  plexus, 
several  cords  proceed  longitudinally  behind  and  before  the 


280 


OF  THE  TRUNK. 


subclavian  artery,  to  the  aorta,  and  here  being  joined  to 
branches  from  the  upper  cardiac  nerve,  they  form  a plexus 
on  the  anterior  and  posterior  faces  of  the  aorta. 

The  Cardiac  Plexus,  consists  of  a very  considerable 
number  of  nervous  filaments,  formed  by  the  combination 
of  the  cardiac  nerves  on  both  sides,  with  branches  sent  off 
from  the  recurrent  nerves,  and  the  par  vagum.  It  is  placed 
between  the  arch  of  the  aorta  and  the  lower  part  of  the 
trachea  and  bronchise,  and  is  fixed  in  loose  cellular  and 
adipose  membrane  at  its  upper  part.  Below,  its  meshes 
are  much  involved  with  the  glands  about  the  bifurcation  of 
the  trachea,  and  on  the  aorta  its  branches  lie  very  close  to 
this  vessel,  being  bound  to  it  by  the  internal  lamina  of  the 
pericardium. 

Several  branches  of  the  plexus,  wind  over  to  the  front  of 
the  aorta  and  pulmonary  artery,  where  they  are  also  con- 
fined closely  to  these  vessels  by  the  internal  lamina  of  the 
pericardium,  and  are  seen  to  enter  into  their  structure. 
The  cardiac  plexus,  penetrating  from  the  base  of  the 
heart  to  the  root  of  the  aorta,  is  diffused  through  the  mus- 
cular structure  of  the  former,  its  trunks  following  the  courses 
of  the  coronary  arteries. 

The  Sympathetic  Nerve,  from  the  last  cervical  ganglion, 
proceeds  over  the  head  of  the  first  rib,  and  descends 
through  the  thorax  in  contact  with  the  heads  of  all  the  libs, 
and  exterior  to  the  pleura.  At  the  upper  edge  of  the  head 
of  each  rib,  it  forms  a ganglion,  which  unites  with  the  in- 
tercostal nerve  behind  it  Sy  one  or  two  branches.  At  the 
lower  part  of  the  thorax,  it  penetrates  into  the  abdomen  be- 
neath the  crus  of  the  diaphragm;  it  then  proceeds  forwards 
and  downwards  on  the  spine,  between  the  tendinous  crus 
of  the  diaphragm  and  the  psoas-magnus  muscle,  and  lies 
on  the  side  of  the  bodies  of  the  lumbar  vertebrae,  being 
near  the  vena  cava  on  the  right  side,  and  the  aorta  on  the 
left.  About  the  middle  of  the  body  of  each  lumbar  verte- 
bra, it  forms  a ganglion,  which  joins  by  one  or  two  nervous 
filaments,  with  the  corresponding  lumbar  nerve,  which  fila- 
ments pass  between  the  bone  and  the  psoas  muscle.  From 


NERVES. 


281 


the  loins,  the  sympathetic  descends  into  the  pelvis  on  the 
inner  side  of  the  foramina  of  the  sacrum  ; here  also  it  forms 
a ganglion  corresponding  with  each  sacral  nerve,  and  de- 
taches a filament  to  join  it.  Finally,  the  sympathetic  termi- 
nates on  the  os  coccygis,  where  the  ultimate  branches  of  the 
opposite  sides  unite. 

From  several  of  the  upper  ganglia  of  the  sympathetic 
in  the  thorax,  fibrillse  depart  which  join  the  posterior  pul- 
monary plexus,  and  also  are  distributed  in  the  form  of  a 
plexus  on  the  aorta.  From  the  sixth,  seventh,  eighth, 
ninth  and  tenth  thoracic  ganglia,  branches  are  sent  off", 
which,  descending  obliquely  on  the  sides  of  the  vertebrae, 
unite  successively  so  as  to  form  a considerable  trunk,  the 
Great  Splanchnic  Nerve,  which  gets  into  the  abdomen 
through  the  foramen  in  the  diaphragm,  for  the  aorta,  or  by 
penetrating  the  crus.  From  the  tenth  and  eleventh  dorsal 
ganglia,  filaments  are,  in  like  manner,  successively  sent 
off,  which  form  one  trunk  that  penetrates  into  the  abdomen, 
through  the  crus  of  the  diaphragm;  this  constitutes  the 
Lesser  Splanchnic  Nerve,  which,  in  part,  unites  to  the 
great  splanchnic  nerve,  and  the  remainder  goes  to  the  renal 
plexus. 

The  Great  Splanchnic  Nerve,  having  entered  the  abdomen 
terminates  in  the  Semilunar  Ganglion.  This  ganglion  is 
situated  on  the  crus  of  the  diaphragm,  and  on  the  sides  of 
the  coeliac  and  superior  mesenteric  arteries.  It  is  frequently 
formed  rather  by  a congeries  of  small  ganglia  arranged 
in  a lunated  form,  than  by  a single  one.  These  small 
ganglia  are  united  by  a reticular  work  of  nerves,  and 
from  them  proceeds  a very  intricate  and  combined  net-work 
of  nervous  fibres,  called  the  Solar  Plexus. 

The  Solar  Plexus,  is  behind  the  stomach,  above  the  pan- 
creas, and  surrounds  with  its  branches,  the  coeliac,  superior 
mesenteric,  and  renal  arteries.  It  is  formed  from  the  semi- 
lunar ganglia  of  both  sides,  and  to  their  ramifications  are 
added  some  from  the  par  vagum  and  phrenic  nerves.  That 
portion  of  the  solar  plexus  on  the  coeliac  artery,  assumes 
the  name  of  coeliac,  and  dismisses  ramifications  in  the  course 


282 


OF  THE  TRUNK. 


of  the  gastric,  hepatic,  and  splenic  arteries  to  the  viscera 
supplied  by  them,  as  the  stomach,  liver,  pancreas,  and 
spleen. 

The  Superior  Mesenteric  Artery  has  around  it  the  Supe- 
rior Mesenteric  Plexus,  which  accompanies  the  arterial 
branches  to  the  right  side  of  the  colon,  to  its  transverse 
portion,  and  to  all  the  small  intestines.  From  the  inferior 
part  of  this  plexus,  proceeds  a detachment  in  front  of  the 
aorta,  to  the  inferior  mesenteric  artery,  which  supplies  the 
left  side  of  the  colon  and  the  rectum. 

From  the  lower  part  of  the  solar  plexus,  arises  the  Renal 
Plexus,  which  surrounds  the  emulgent  artery,  and  is  dis- 
tributed to  the  kidney  and  to  the  capsula  renalis.  The 
renal  plexus  detaches  near  the  kidney  a few  fibres,  which 
being  joined  by  others  from  the  first  or  second  lumbar 
nerves,  accompany  the  spermatic  artery,  and  are  there- 
fore called  the  Spermatic  Plexus.  In  the  male  they  are 
distributed  on  the  cord  and  testis,  and  in  the  female  on  the 
ovarium  and  fallopian  tube. 

From  the  lower  part  of  the  renal  and  solar  plexus,  there 
proceeds  a reticulated  structure  of  nerves  in  front  of  the 
aorta,  as  low  down  as  its  bifurcation.  This  is  joined  by 
fibres  on  each  side,  from  the  sympathetic  of  the  loins.  It 
divides,  and  following  the  course  of  the  hypogastric  ar- 
tery on  each  side,  is  distributed  to  the  bladder,  rectum, 
and  vesiculte  seminales  of  the  male,  and  to  the  uterus, 
vagina,  bladder,  and  rectum  of  females.  This  is  the  Hy- 
pogastric Plexus,  which  is  farther  increased  by  filaments 
from  the  sacral  parts  of  the  sympathetic. 


A View  of  the  Great  Sympathetic  Nerve. 


1.  The  Plexus  on  the  Carotid  Ar- 

tery in  the  Carotid  Fora- 
men. 

2.  Sixth  Nerve  (Motor  Externus. 

3.  First  Branch  of  the  Fifth  or 

Ophthalmic  Nerve. 


4.  A branch  on  the  Septum  Na- 

rium  going  to  the  Incisive 
Foramen. 

5.  The  Recurrent  Branch  or  Vi- 

dian Nerve  dividing  into 
the  Carotid  and  Petrosal 
Branches. 


NERVES. 


283 


Fig.  55. 


6.  Posterior  Palatine 

Branches. 

7.  The  Lingual  Nerve, 

joined  by  the  Chor. 
da  Tympani. 

8.  The  Portio  Dura  of 

the  Seventh  Pair, or 
the  Facial  Nerve. 

9.  The  Superior  Cervi- 

cal Ganglion. 

10.  The  Middle  Cervi- 

cal Ganglion. 

11.  The  Inferior  Cervi- 

cal Ganglion. 

12.  The  Roots  of  the 

Great  Splanchnic 
Nerve  arising/rom 
the  Dorsal  Gan- 
glia. 

13.  The  Lesser  Splanch- 

nic Nerve. 

14.  The  Renal  Plexus. 

15.  The  Solar  Plexus. 

16.  TheMesentericPlex. 

us. 

17.  The  Lumbar  Gan- 

glia. 

18.  The  Sacral  Ganglia. 

19.  The  Vesical  Plexus. 

20.  The  Rectal  Plexus. 

21.  The  Lumbar  Plexus 

(Cerebro-Spinal.) 

22.  The  Rectum. 

23.  The  Bladder. 

24.  The  Pubis. 

25.  The  Crest  of  the  Ili- 

um. 

26.  The  Kidney. 

27.  The  Aorta. 

28.  The  Diaphragm. 

29.  The  Heart. 

30.  The  Larynx. 

31.  The  Sub-Maxillary 

Gland. 

32.  The  Incisor  Teeth. 

33.  Nasal  Septum. 

34.  Globe  of  the  Eye. 
35.36.  Cavity  of  the  Cra- 

nium.^ 


284 


OF  THE  TRUNK. 


The  other  nerves  of  the  trunk  consist  of  the  Dorsal,  the 
Lumbar,  and  the  Sacral.  Each  arises  as  a solitary  trunk 
from  its  appropriate  spinal  ganglion,  and  very  soon  divides 
into  anterior  and  posterior  fasciculi.  The  posterior  is  dis- 
tributed to  the  muscles  of  the  back,  but  the  anterior  has  a 
destination  not  so  uniform. 

The  anterior  branches  of  the  dorsal  nerves,  are  all  con- 
nected to  the  ganglia  of  the  sympathetic,  and  running 
between  the  internal  and  external  intercostal  muscles,  are 
distributed  to  the  parietes  of  the  thorax  and  abdomen.  The 
first  dorsal  nerve  joins  the  axillary  plexus.  The  second 
sends  a branch  through  the  external  intercostal  muscle,  to 
the  axilla,  which  joins  with  a branch  of  the  internal  cuta- 
neous nerve  of  the  arm,  and  is  supposed,  as  it  also  sends  a 
filament  to  the  lower  cervical  ganglion  of  the  sympathetic, 
to  establish  the  sympathy  between  the  arm  and  the  heart 
in  angina  pectoris.  The  third  dorsal,  also  sends  a branch 
to  the  axilla. 

The  upper  lumbar  nerves  are  employed  upon  the  integu- 
ments of  the  abdomen,  and  in  the  formation  of  the  lumbar 
plexus,  which  supplies  the  front  of  the  thigh  and  leg.  The 
lower  lumbar  nerves,  and  the  sacral,  form  the  Sciatic 
plexus,  which  supplies  the  posterior  parts  of  the  lower 
extremity. 

The  farther  consideration  of  the  spinal  nerves,  is  referred 
to  the  anatomy  of  the  limbs. 


NERVES. 


285 


SECTION  II. 

Of  the  Blood-Vessels  of  the  Trunk . 

The  course  of  the  aorta,  from  its  origin  to  its  passage 
through  the  diaphragm,  has  already  been  mentioned,  (see 
Thorax;)  as  well  as  the  fact  that  a line  to  subtend  the  base 
of  its  curvature,  must  be  drawn  from  the  sternal  extremity 
of  the  third  rib  on  the  right,  to  the  dorsal  extremity  of  the 
third  rib  on  the  left  side.  The  first  branches  given  off  af- 
ter the  coronary  arteries,  are  the  Arteria  Innominata,  the 
Left  Carotid,  and  the  Left  Subclavian.  The  Arteria  L\- 
nominata  is  in  advance  of  the  others,  and  divides  after  an 
inch  or  an  inch  and  a half  of  length,  into  Right  Carotid  and 
Right  Subclavian.  For  an  exposition  of  the  course  of  the 
Carotids,  see  the  article  Neck. 

The  Subclavian  Artery,  before  it  passes  between  the 
scaleni  muscles,  sends  off  five  branches : of  which  the  Infe- 
rior Thyroid,  the  Vertebral,  and  the  Transverse  Artery  of 
the  neck  are  mentioned  in  the  article  Neck.  The  remain- 
ing two,  to  wit,  the  Internal  Mammary  and  the  Superior  In- 
tercostal belong  to  the  trunk. 

The  Internal  Mammary  Artery,  after  its  origin,  de- 
scends immediately  along  the  internal  margin  of  the  scale- 
nus anticus,  and  places  itself  between  the  pleura  and  the 
cartilages  of  the  true  ribs,  about  three  fourths  of  an  inch 
from  the  outer  edge  of  the  sternum;  it  gets  into  the  abdomen, 
and  is  distributed  finally  to  the  rectus  muscle,  anastomosing 
in  it  with  the  epigastric  artery.  It  sends  a branch  (Phrenica 
Superior)  which  attends  the  phrenic  nerve  on  the  side  of  the 
pericardium ; it  then  supplies  the  intercostal  muscles,  anas- 
tomoses with  the  intercostal  arteries,  and  sends  some  branches 
to  the  mamma. 


286 


OF  THE  TRUNK. 


The  Superior  Intercostal  Artery,  arising  from  the 
under  surface  of  the  subclavian,  opposite  the  inferior  thy- 
roid, runs  across  the  neck  of  the  first  rib,  and  supplies  the 
two  upper  intercostal  spaces ; it  also,  sometimes,  supplies 
the  third  intercostal  space. 

Below  its  curvature,  in  the  thorax,  the  aorta  gives  off  the 
(Esophageal,  the  Bronchial,  the  Posterior  Mediastinal,  and 
the  Intercostal  Arteries. 

The  Bronchial  Arteries,  are  vessels  intended  for  the 
nourishment  of  the  lungs;  the  right  comes  from  the  superior 
aortic  intercostal  artery,  and  the  left  from  the  aorta  ; this  ar- 
rangement is  not  uniform,  for  sometimes  both  come  from  the 
aorta. 

The  (Esophageal  Arteries,  are  five  or  six  in  number, 
and  are  spent  upon  the  oesophagus,  as  their  name  implies ; 
the  lowermost  descends  to  the  stomach. 

The  Posterior  Mediastinal,  as  their  name  indicates, 
supply  the  posterior  mediastinum,  and  its  contents. 

The  Aortic  Intercostals,  supply  commonly,  the  ten 
inferior  intercostal  spaces.  The  upper  ones  have  to  rise 
somewhat  obliquely  to  get  to  their  destination,  whereas,  the 
lower  ones  pass  nearly  horizontally.  The  right  are  longer 
than  the  left,  and  the  oesophagus  is  in  front  of  them. 
Each  one  joins  the  rib  near  its  tubercle,  and  keeps  at  its 
lowTer  edge,  between  the  internal  and  external  intercostal 
muscles  in  the  groove  of  the  bone.  The  first  branch  is  the 
dorsal,  given  off  near  the  spine  ; which  passes  to  the  muscles 
of  the  back,  and  despatches  an  arteriole  through  the  inter- 
vertebral foramen  to  the  medulla  spinalis.  When  the  inter- 
tercostal  arrives  near  the  middle  of  the  rib,  it  sends  off  a branch 
which  passes  near  the  upper  edge  of  the  lower  rib.  When 
it  has  got  two-thirds  of  the  length  of  the  rib,  it  leaves  the 
lower  edge  to  be  distributed  to  the  intercostal  space  and 
contiguous  parts. 

The  Abdominal  Aorta,  passes  almost  in  front  of  the  ver- 
tebrae, being  pushed  but  very  little  to  the  left  of  the  median 


NERVES. 


287 


line.  It  gives  off  several  large  branches  to  the  viscera,  and 
at  the  intervertebral  space  of  the  fourth  and  fifth  vertebrae  of 
the  loins,  it  divides  into  the  two  Primitive  Iliacs. 

The  Phrenic  Arteries,  come  from  the  aorta,  immedi- 
ately on  the  latter  emerging  between  the  crura  of  the  dia- 
phragm. They  are  two  in  number,  and  named  from  their 
situations,  Right  and  Left ; they  ramify  on  the  concave  sur- 
face of  the  diaphragm.  Their  origin  is  subject  to  varia- 
tions. 

The  C celiac  Artery,  (Arteria  Cceliaca)  is  immediately 
helow  the  phrenic  ; it  is  a large  vessel  about  half  an  inch 
long,  standing  from  the  aorta  at  right  angles,  and  divides 
into  the  Hepatic,  Gastric,  or  Coronary,  and  Splenic  Arte- 
ries. This  division  is  the  Tripus  Halleri. 

The  Hepatic  Artery,  goes  to  the  liver  through  the  cap- 
sule of  Glisson,  and  is  distributed  through  this  viscus.  Near 
the  liver  it  sends  off  the  Right  Gastro-Epiploic,  which  is 
distributed  to  the  great  curvature  of  the  stomach,  and  the 
contiguous  parts. 

The  Gastric  Artery,  is  between  the  other  two  ; it  joins 
the  stomach  near  the  cardia,  and  proceeds  along  the  lesser 
curvature  to  the  pylorus,  supplying  contiguous  parts  of  the 
stomach. 

The  Splenic  Artery,  is  the  largest  of  the  three.  It^oes 
tortuously  along  the  upper  edge  of  the  pancreas  to  the 
spleen;  in  its  course  it  sends  to  the  stomach  the  Left  Gastro- 
Epiploic,  which  is  spent  on  its  greater  extremity  and  the 
left  side  of  the  greater  curvature.  From  this  vessel  also  are 
derived  the  Vasa  Brevia  of  the  stomach,  and  the  Arteries  of 
the  Pancreas. 


OF  THE  TRUNK. 


288 


A View  of  the  Aorta  in  its  whole  length,  and  of  its  Branches, 
« as  given  by  a section  of  the  Anterior  Parietes  of  the 
Trunk. 


Fig.  56. 


1.  Commencement  and 

Arch  of  the  Aorta. 

2.  Thoracic  Aorta. 

3.  Abdominal  Aorta. 

4.  Arteria  Innominata. 

5.  Right  Primitive  Ca- 

rotid. 

6.  Superior  Thyroid. 

7.  Right  Sub-Ciavian. 

8.  Vertebral. 

9.  Inferior  Thyroid. 

10.  Anterior  Cervical. 

11.  Transverse  Cervical. 

12.  Superior  Scapular. 

13.  Superior  Intercostal. 

14.  Section  of  internal 

Mammary. 

15.  Left  Primitive  Ca. 

rotid. 

1 6.  Left  Sub-Clavian. 

17.  A small  Artery  to 

the  Superior  Me- 
diastinum. 

18.  Some  of  the  L'pper 

Intercostal  Arte- 
ries. 

19.  (Esophageal  Arte- 

ries. 

20.  Phrenic  Arteries. 

here  coming  olf 
from  the  Cceliac. 

21.  Remains  of  the  Dia- 

phragm,and  com- 
mencement of  the 
Celiac  Artery. 

22.  Tripod  of  Haller,  or 

Division  of  the 
Codiac,  into  He- 
patic, Gastric  and 
Splenic  Arteries. 


23.  Superior  Mesenteric,  cut  off. 

24.  Emulgent  Arteries. 

25.  Inferior  Mesenteric. 

26.  Division  of  the  Aorta  into  Iliacs. 

27.  Middle  Sacral — last  Branch  of  the  Aorta. 

28.  Primitive  Iliacs. 

29.  External  Iliacs. 


ARTERIES  OF  ABDOMEN. 


289 


30.  Epigastric  Artery. 

31.  Circumflexa  Ilii. 

32.  Internal  Iliac  Artery. 

33.  Ileo-Lumbar. 

34.  Lateral  Sacral. 


35.  Gluteal. 

36.  Vesical  Arteries. 

37.  Obturator. 

38.  Ischiatic. 

39.  Internal  Pudic. 


The  Superior  Mesenteric,  (Arteria  Mesenterica  Supe- 
rior) is  about  half  an  inch  below  the  coeliac,  and  is  nearly 
of  the  same  size  ; it  passes  downwards  under  the  pancreas 
and  above  the  duodenum,  supplying  all  the  small  intestines, 
the  right  side  of  the  colon,  and  its  transverse  arch.  It  has  a 
great  many  anastomoses  in  it ; constituted  by  a series  of 
arcades,  one  upon  the  other,  diminishing  in  size  as  they 
approach  the  intestine.  That  branch  of  the  artery  which 
supplies  the  junction  of  the  ileum  with  the  colon,  is  called 
Arteria  Ileo-Colica;  that  which  supplies  the  right  side  of  the 
great  intestine,  is  the  Arteria  Colica  Dextra ; and  that  which 
supplies  the  arch  of  the  colon,  is  the  Colica  Media. 

The  Emulgent  Arteries,  (Arterice  Emulgentes)  are  two 
in  number,  one  from  each  side  of  the  aorta,  coming  off  at 
right  angles  from  it,  and  not  much  inferior  in  size  to  the 
mesenteric.  The  right  is  the  longest,  and  passes  behind 
the  ascending  vena  cava.  They  go  to  the  kidneys,  and  to 
the  cap  sub:',  renales.  The  arterial  distribution  from  the 
aorta  here,  is  subject  to  variations,  the  arteries  of  the  cap- 
sulse  renales  coming  sometimes  from  the  aorta,  and  on  other 
occasions,  from  the  emulgents.  There  are  also  several  arteries 
going  to  the  adipose  matter  in  which  the  kidneys  are  placed, 
equally  unsettled  in  their  origin. 

The  Spermatic  Arteries,  (Arterise  Spermatic®)  arise  im- 
mediately below  the  emulgents,  one  on  each  side ; they  are 
about  the  size  of  a crow-quill,  and  are  remarkable  for  their 
length.  They  pass  downwards  to  the  testicles,  behind  the 
peritoneum,  and  before  the  pso®  muscles,  not  far  from  the 
ureters,  spermatic  plexus  of  nerves,  and  spermatic  veins. 
At  the  internal  abdominal  ring,  the  spermatic  artery  meets 
with  the  vas  deferens,  and  constituting  a part  of  the  sper- 
matic cord,  is  distributed  on  the  testicle  in  the  manner  de- 
scribed in  the  account  of  that  organ.  In  the  female,  these 
arteries  go  to  the  ovaria,  fallopian  tubes,  and  uterus. 


19 


290 


OF  THE  TRUNK. 


The  Inferior  Mesenteric,  (Arteria  Mesenterica  Inferior 
arises  below  the  spermatics  ; it  is  much  smaller  than  the  su- 
perior. Three  branches  proceed  from  it,  called  the  Left 
Colic  Arteries,  from  their  distribution  to  the  left  side  of  the 
colon,  and  are  distinguished  from  each  other  by  the  terms 
Superior,  Middle,  and  Inferior.  The  superior,  anastomoses 
with  the  colica  media,  forming  with  it  the  great  Mesocolic 
Arch.  The  others  supply  the  sigmoid  flexure  of  the  colon, 
and  the  part  just  above  it.  A branch  is  continued  from  the 
inferior  mesenteric,  to  the  rectum,  constituting  the  Superior 
Hemorrhoidal  Artery. 

From  the  centre  of  the  fork  formed  by  the  bifurcation  of 
the  aorta,  there  proceeds  a small  arterial  tube,  about  the  size 
of  a crow-quill,  called  the  Middle  Sacral,  from  its  running 
down  to  the  os  coccygis,  just  over  the  middle  line  of  the 
sacrum.  It  sends  branches  on  either  side,  towards  the  fora- 
mina in  the  sacrum. 

The  Lumbar  Arteries,  (Arteriae  Lumbares)  are  froc 
three  to  five  in  number,  on  either  side ; they  pass  off  at  righ' 
angles  from  the  aorta  over  the  sides  of  the  lumbar  vertebra 
some  of  their  branches  penetrate  the  intervertebral  foramin; 
to  get  to  the  medulla  spinalis:  others  pass  to  the  muscles  o 
the  back.  Besides  which,  the  lower  parts  of  the  parietes  o 
the  abdomen  are  supplied  by  them.  They  inosculate  wit) 
the  circumflexa  ilii,  with  the  epigastric,  and  with  the  glutea 
arteries. 

The  Primitive  Iliacs,  (Art.  Iliacae  Communes)  one  01 
each  side,  are  formed  by  the  termination  of  the  abdomina 
aorta;  they  extend  from  the  fourth  lumbar  vertebra  to  th< 
sacro-iliac  junction,  opposite  to  which  they  divide  into  tw< 
trunks,  the  External  Iliac  Artery,  and  the  Hypogastric.  Ii 
this  course  they  give  off  no  collateral  branch  of  any  const 
quence,  and  are  crossed  by  the  ureters. 

The  Hypogastric  or  Internal  Iliac,  (Arteria  Iliaca  In 
terna,  or  Ramus  Hypogastricus,)  gives  off  several  branches 
the  origins  of  which  differ  considerably.  The  main  trunl 
itself  is  of  various  lengths,  and  is  distributed  to  the  viscer 
of  the  pelvis,  and  to  the  muscles  on  its  external  surface 
Sometimes  it  is  previously  divided  into  two  principal  trunk: 


ARTERIES  OF  ABDOMEN. 


291 


an  anterior  and  a posterior.  From  it  the  following  branches 
proceed. 

1.  The  Ilio-Lumbar  Artery,  (Arteria  Ilio-Lumbalis,)  is 
commonly  the  first  branch  of  the  hypogastric,  or  of  its  poste- 
rior trunk.  Arising  from  its  posterior  external  part,  it  passes 
outwardly  between  the  psoas  rnagnus  and  iliacus  internus 
muscles,  and  divides  into  twro  branches,  one  of  which  is  dis- 
tributed to  the  loins,  and  the  other,  upon  the  iliacus  internus 
muscle. 

2.  The  Lateral  Sacral  Arteries,  (Arterise  Sacrae  La- 
terales,)  come  next,  arising  by  one  or  more  trunks  from  the 
hypogastric,  or  one  of  its  large  branches  ; they  commonly 
equal  in  number  the  foramina  of  the  sacrum,  and  passing 
into  them,  are  distributed  upon  the  inferior  part  of  the 
cauda  equina ; they  also  anastomose  with  the  middle  sacral 
artery. 

3.  The  Obturator  Artery,  (Arteria  Obturatoria,)  comes 
from  the  hypogastric,  or  one  of  its  trunks,  and  passes  along 
parallel  with  the  brim  of  the  pelvis  ; going  through  the  ob- 
turator foramen,  it  is  distributed  to  the  hip  joint,  and  to  the 
muscles  on  the  upper  internal  part  of  the  thigh.  Its  origin 
is  occasionally  from  the  epigastric. 

4.  The  Middle  Hemorrhoidal  Artery,  (Arteria  He- 
morrhoidea  Media,)  comes  sometimes  from  the  gluteal.  It 
is  thus  named  from  its  relative  position  to  the  upper  and 
lower  hemorrhoidal,  on  the  rectum.  Besides  going  to  this 
organ,  it  supplies  the  prostate  gland,  and  the  vesiculae 
seminales  of  the  male,  and  the  vagina  and  bladder  in  fe- 
males. 

5.  The  Uterine  Artery,  (Arteria  Uterina,)  is  peculiar  to 
females,  and  gets  to  the  uterus,  between  the  laminte  of  the 
broad  ligaments. 

6.  The  Vesical  Arteries,  (Arterise  Vesicales,)  are  de- 
rived from  what  was  the  umbilical  artery  of  the  foetus,  and 
are  distributed  to  the  bladder. 


292 


OF  THE  TRUNK. 


The  Arteries  of  the  Pelvis  and  Thigh,  as  seen  from  the  Inner 
Side,  by  a Vertical  Section. 

Fig.  57. 


1.  Inferior  Extremity  of  the  Ab- 

dorninal  Aorta,  just  where 
it  divides  into  the  Iliac  Ar- 
teries. 

2.  Right  Primitive  Iliac. 

3.  Right  External  Iliac. 

4.  Origin  of  Epigastric  Artery. 

5.  Circumflexa  llii. 

G.  Hypogastric  or  Internal  Iliac 
Artery. 

7.  lleo-Lumbar. 

8.  Gluteal. 

9.  Obturator. 

10.  Lateral  Sacral. 

11.  Vesical  Arteries,  cut  off. 

12.  Middle  Hemorrhoidal. 

13.  Internal  Pudic. 

14.  Ischiatic. 

15.  Origin  of  the  Femoral  Artery 

at  the  Crural  Arch. 

1G.  Point  where  it  passes  through 
the  Adductor  Muscle. 

17.  Profunda  Major. 

18.  Internal  Circumflex. 

19.  First  Perforating  Artery. 

20.  Second  Perforating  Artery. 

21.  Third  Perforating  Artery. 

22.  Another  Perforating  Artery. 

23.  Femoral  seen  in  the  Adduc- 

tors. 

24.  The  Anastomotica  of  the  Fe- 

moral. 

25.  A Branch  to  the  Saitorius 

Muscle. 

26.  Popliteal  Artery. 

27.  The  same  Artery  behind  the 

Knee-joint  underthe  Soleus 
Muscle. 

23.  A Supernumerary  Aiticu'ar 
Artery. 


2 '.  Superior  Internal  Articular  Artery. 

30.  Inferior  Internal  Articular  Artery. 

31.  Anastomosis  of  these  with  Anastomotica. 


What  remains  of  the  hypogastric,  consists  in  two  large 
branches,  the  Gluteal  and  the  Ischiatic. 


ARTERIES  OF  ABDOMEN. 


293 


7.  The  Gluteal  Artery,  (Arteria  Glutsea,)  passes  out 
of  the  pelvis  at  the  upper  part  of  the  ischiatic  foramen  above 
the  pyriformis  muscle;  it  is  situated  in  contact  with  the  edge 
of  the  bone,  and  its  trunk  is  accessible  from  the  external 
parts  of  the  pelvis.  Having  got  to  its  outside,  the  trunk  of 
the  gluteal  divides  immediately  into  branches  which  are  dis- 
tributed upon  the  gluteal  muscles. 

8.  The  Ischiatic  Artery,  (Arteria  Ischiadica,)  coming 
from  the  inferior  part  of  the  hypogastric,  is  situated  before 
the  belly  of  the  pyriformis  muscle,  and  issues  from  the  pel- 
vis below  its  inferior  edge,  and  in  front  of  the  sciatic  nerve. 
It  pursues  its  course  downwards  on  the  back  part  of  the 
thigh,  between  the  trochanter  major  and  the  tuberosity  of 
the  ischium,  being  then  at  the  internal  edge  of  the  sciatic 
nerve.  It  is  distributed  to  the  inferior  edge  of  the  gluteus 
maximus,  and  to  the  muscular  structure  near  the  sacrum  and 
coccyx ; also,  to  the  muscles  on  the  back  and  upper  parts 
of  the  thigh. 

The  Internal  Pcjdic  Artery,  (Arteria  Pudica  Interna,) 
irises  from  the  Ischiatic  within  the  pelvis,  emerges  from  the 
oelvis  with  the  ischiatic,  and  then  returns  betwreen  the  two 
;acro-sciatic  ligaments,  to  the  inner  side  of  the  tuberosity  of 
he  ischium,  and  continues  on  the  inner  side  of  the  ramus  of 
he  ischium  and  of  the  pubis,  towards  the  symphysis.  In  this 
course,  it  gives  off  several  branches  in  the  following  order, 
i small  branch  to  lower  edge  of  pyriformis  muscle.  The 
bower  Hemorrhoidal  Artery  to  the  lower  part  of  the  rectum, 
md  to  the  sphincter  ani  muscle.  To  the  back  part  of  the 
:crotum,  the  perineal  muscles  and  the  skin,  it  gives  the  Pe- 
ineal  Artery,  originating  near  the  transversus  perinei  muscle 
md  passing  in  its  direction.  Upon  the  arrival  of  the  in- 
ernal  pudic  near  the  penis,  it  detaches  to  this  body,  a branch 
vhich  penetrates  and  ramifies  minutely  through  the  struc- 
ure  of  the  corpus  spongiosum  urethrae.  At  the  symphysis 
)f  the  pubes,  it  sends  off  a branch  which  gets  to  the  dorsum 
>f  the  penis,  and  extends  longitudinally,  as  far  as  the  glans, 
ieing  distributed  to  the  elastic  ligament,  to  the  integuments, 
md  to  the  prepuce ; this  is  the  Superficialis  Dorsi  Penis, 
finally,  the  terminating  branch  of  the  internal  pudic  pene- 
rates  into  the  corpus  cavernosum,  passes  straight  forwards 


294 


OF  THE  TRUNK. 


on  the  septum,  and  is  distributed  to  the  cells,  by  very  mi- 
nute branches,  some  of  which  go  to  the  other  side. 

The  External  Iliac  Artery,  (Arteria  Hiaca  Externa,) 
seems  to  be  the  continuation  of  the  common  iliac ; it  passes 
along  the  brim  of  the  pelvis  on  the  inner  side  of  the  psoas 
magnus  muscle,  to  Poupart’s  Ligament.  Here,  it  is  about 
half-way  between  the  symphysis  of  the  pubes,  and  the  ante- 
rior superior  spinous  process  of  the  ilium,  having  the  ante- 
rior crural  nerve  on  its  outside,  and  the  external  iliac  vein 
on  its  inside.  It  gives  off  no  branches,  till  it  reaches  Pou- 
part’s ligament,  when  the  Epigastric  arises  from  it. 

The  Epigastric  Artery,  (Arteria  Epigastrica,)  at  first 
passes  inwards;  it  then  rises  upwards  obliquely,  till  it  reaches 
the  exterior  edge  of  the  rectus  muscle.  Continuing  after- 
wards  to  ascend,  it  is  spent  upon  the  anterior  parietes  of  the 
abdomen  by  many  branches,  some  of  which  inosculate  with 
the  internal  mammary. 

The  Circumflex  Artery,  (Arteria  Circumflexa  Ilii,) 
arises  from  the  external  iliac  near  the  epigastric.  It  runs 
along  the  posterior  edge  of  Poupart’s  ligament,  to  the  spi- 
nous process  of  the  ilium,  thence  it  continues  its  course 
near  the  internal  margin  of  the  crista,  being  distributed  to 
the  iliacus  internus  muscle.  A branch  of  it  near  the  spinous 
process,  rises  upwards,  and  is  spent  upon  the  abdominal 
muscles.  It  anastomoses  with  the  arteria  ilio-lumbalis. 


VEINS  OF  THE  TRUNK. 

The  Superior  Cava,  (Cava  Descendens,)  is  sufficiently 
alluded  to,  in  the  description  of  the  thorax,  to  render  a far- 
ther notice  of  it  here  unnecessary.  It  receives  the  blood 
from  the  left  arm  and  side  of  the  head,  by  a trunk  (the  Vena 
Innominata)  formed  by  the  union  of  the  left  subclavian  and 
internal  jugular  vein,  which  crosses  the  sternum  obliquely  a 
little  below  its  superior  edge.  This  venous  trunk,  and  the 
corresponding  one  belonging  to  the  right  arm,  and  the  right 
side  of  the  head,  which  descends  vertically,  constitute  in  fact 
by  uniting,  the  Descending  Cava. 


VEINS  OF  TRUNK. 


295 


On  a horizontal  line  with  the  upper  edge  of  the  root  of 
the  right  lung,  is  the  point  where  the  descending  cava  is 
joined  by  the  Vena  Azygos.  The  latter  is  formed  by  the 
union,  into  one  trunk  successively,  of  the  ten  inferior  inter- 
costal veins  of  the  right  side.  About  the  sixth  dorsal  verte- 
bra, this  trunk  is  joined  by  one  formed  by  the  successive 
union  of  the  six  inferior  intercostal  veins  on  the  left  side. 
The  trunk  of  the  vena  azygos  as  stated,  is  on  the  right 
side  of  the  posterior  mediastinum,  and  forms  a regular  and 
beautiful  arch,  over  the  root  of  the  right  lung. 

The  six  superior  Intercostal  Veins  of  the  left  side,  dis- 
charge into  the  left  subclavian  vein  by  a common  trunk  ; the 
two  superior  of  the  right  side,  into  the  descending  cava. 

The  Internal  Mammary  Vein  has  nothing  very  peculiar; 
it  observes  the  course  of  its  artery,  and  empties  into  the 
subclavian  vein  near  its  origin. 

The  Vena  Cava  Ascendens  is  formed  in  the  lower  part 
of  the  abdomen,  by  the  union  of  the  external  and  internal 
iliac  veins  into  the  common  iliacs,  and  the  subsequent  junc- 
tion of  the  latter,  at  the  fourth  lumbar  vertebra.  This  vein 
ascends  on  the  right  of  the  aorta,  receives  the  Lumbar, 
the  Spermatic,  the  Emulgent,  the  Capsular,  the  Hepatic 
and  the  Phrenic  Veins,  and  in  its  course,  penetrates  the 
right  opening  of  the  diaphragm  and  terminates  in  the  right 
auricle. 

Each  artery  of  the  pelvis  has  its  corresponding  vein;  it 
is  therefore  unnecessary  to  describe  the  latter,  except  in 
regard  to  peculiarities.  About  the  neck  of  the  bladder, 
vesiculae  seininales,  and  the  base  of  the  prostate,  there  is  a 
considerable  accumulation  of  veins,  forming  a very  vascu- 
lar plexus;  they  come  originally  from  the  Vena  Ipsius 
Penis,  and  from  the  proper  vesical  veins. 

The  several  veins  of  the  pelvis  derived  from  the  ischi- 
atic,  gluteal,  and  internal  pudic  arteries,  &c.,  accumulate 
at  the  sacro-iliac  junction  into  one  trunk,  the  Internal  Iliac 
Vein,  which  ascends  by  the  side  of  the  hypogastric  artery, 
and  joins  the  external  iliac  vein. 

The  Ascending  Cava  is  joined  at  its  fork,  by  the  Middle 
Sacral  Vein,  and  above  it,  by  the  Lumbar  Veins  on  each 


296 


OF  THE  TRUNK. 


side.  The  Right  Spermatic  Vein  discharges  into  the  Ascend- 
ing Cav  i,  but  the  left  into  the  Emulgent  of  that  side.  The 
emulgent  and  capsular  veins,  correspond  with  the  arteries, 
the  right  being  shorter  than  the  left,  from  the  position  of 
the  vena  cava.  The  left  emulgent  vein  is  in  front  of  the 
aorta. 

The  Ascending  Cava  is  next  joined  by  the  hepatic  veins 
which  have  been  mentioned,  and  lastly,  by  the  phrenic. 

The  Venous  Trunks,  derived  from  the  superior  and  in- 
ferior mesenteric  arteries,  and  from  those  of  the  coeliac 
which  do  not  go  to  the  liver,  as  the  splenic  and  gastric, 
form  that  large  trunk,  the  Vena  Portarum,  the  history  of 
which  is  given  in  the  account  of  the  liver. 


SECTION  III. 

The  Thoracic  Duct , ( Vas  Chyliferus.) 

The  common  trunk  of  the  absorbent  system,  commences 
most  commonly  at  the  second  or  third  lumbar  vertebra,  in 
front  of  its  body,  by  the  union  of  the  absorbent  vessels  of 
the  lower  extremities,  pelvis,  and  intestines.  This  vessel 
immediately  after  its  formation,  is  sometimes  subjected  to 
a dilatation  of  various  shapes  and  lengths,  called  the  Re- 
ceptaculum  Chyli  ,*  after  which,  it  proceeds  regularly  up- 
wards in  front  of  the  vertebra,  between  the  vena  azygos 
and  the  aorta,  to  the  upper  part  of  the  thorax.  It  passes 
between  the  crura  of  the  diaphragm,  and  for  some  part  of 
its  course,  is  immediately  behind  the  oesophagus.  At  the 
fourth  dorsal  vertebra,  it  begins  to  incline  to  the  left,  and 
preserving  that  direction,  it  gets  into  the  neck  as  high  as 
the  upper  edge  of  the  seventh  cervical  vertebra,  and  just 
to  its  left  side.  Here  it  forms  an  arch,  which  descends 
forwards  and  outwards,  in  front  of  the  subclavian  artery, 
between  the  internal  jugular  vein,  and  the  scalenus  anticus 
muscle  ; and  then  terminates  by  an  orifice  protected  by  two 
valves,  in  the  fork  formed  by  the  junction  of  the  left  inter- 
nal jugular  and  subclavian  veins. 


THORACIC  DUCT. 


297 


Fig.  58. 


A View  of  the  Course  and  Termi- 
nation of  the  Thoracic  Duct. 

1.  Arch  of  the  Aorta. 

2.  Thoracic  Aorta. 

3.  Abdominal  Aorta. 

4.  Arteria  Innominata. 

5.  Left  Carotid. 

6.  Left  Sub-CIavian. 

7.  Superior  Cava. 

8.  The  two  Vena;  Innominat®. 

9.  The  Internal  Jugular  and  Sub-CIa- 

vian Vein  at  each  side. 

10.  The  Vena  Azygos. 

1 1.  The  Termination  of  the  Vena  Hemi- 

Azygos  in  the  Vena  Azygos. 

12.  The  Receptaculum  Chyli  .-  several 

Lymphatic  Trunks  are  seen 
opening  into  it. 

13.  The  Thoracic  Duct,  dividing  op- 

posite the  Middle  Dorsal  Verte- 
bra, into  two  branches,  which 
soon  reunite;  the  course  of  the 
Duct  behind  the  Arch  of  the 
Aorta  and  Left  Sub-CIavian  Ar- 
tery is  shown  by  a Dotted  Line. 

14.  The  Duct  making  its  turn  at  the 

Root  of  the  Neck,  and  receiving 
several  Lymphatic  Trunks  pre- 
vious to  terminating  in  the  Pos- 
terior Angle  of  the  Junction  of 
the  Internal  Jugular  and  Sub- 
CIavian  Veins. 

15.  The  Termination  of  the  Trunk  of 

the  Lymphatics  of  the  Upper  Ex- 
tremity. 


Several  interesting  varieties  occur  in  the  Yas  Chyliferus; 
sometimes  two  trunks  are  formed  originally  on  the  lumbar 
vertebrae,  which  run  parallel  with  each  other,  and  then 
unite  at  the  lower  dorsal  vertebra.  The  thoracic  portion 
of  the  duct  varies  in  size  and  continuity,  being  divided 
once  or  oftener  into  two  trunks,  which  unite  again,  and 
being  also  contracted  at  particular  points.  The  cervical, 
or  terminating  portion  of  the  duct,  is  occasionally  divided 
into  two  tubes  which  have  separate  orifices.  There  is  a 
very  good  plate  in  Caldani,  representing  the  occasional 
terminations  of  the  lymphatic  trunks,  in  the  region  of  the 


298 


OF  THE  TRUNK. 


neck;  in  this  plate  the  thoracic  duct  empties  after  a consi- 
derable dilatation,  into  the  internal  jugular  vein,  about  an 
inch  above  its  junction  with  the  subclavian ; and  the  lym- 
phatics of  the  left  side  of  the  head  and  neck,  form  two 
trunks,  which  discharge  separately,  into  the  convex  side 
of  the  Thoracic  duct;  the  lymphatics  of  the  left  upper  extre- 
mity form  a trunk,  whose  orifice  is  in  the  subclavian  vein, 
about  an  inch  below  its  junction  with  the  internal  jugular. 

The  lymphatics  of  the  right  arm,  lung,  right  side  of  the 
neck  and  head,  converge  towards  the  junction  of  the  right 
subclavian  and  internal  jugular  by  four  trunks,  and  then 
unite  into  one,  which  discharges  itself  at  the  posterior 
face  of  this  junction.  The  venous  orifice  of  this  trunk, 
like  that  of  the  Thoracic  Duct,  is  secured  from  a regurgi- 
tation of  blood,  by  one  or  more  valves. 


CHAPTER  VI. 


OF  THE  MUSCLES  OF  THE  BACK. 

Make  an  incision  through  the  integuments  from  the 
lower  part  of  the  occiput  to  the  os  coccygis,  directly  over 
the  spinous  processes  of  the  vertebrae.  Make  a second 
incision  from  the  upper  end  of  the  first,  to  the  lobe  of  the 
ear.  Make  a third  cut  through  the  integuments  from  the 
acromion  process  to  the  posterior  fold  of  the  arm-pit. 
Lastly,  make  a cut  horizontally  from  the  acromion  process 
to  the  spine. 

Begin  the  dissection  at  the  last  cut,  and  raise  the  upper 
and  then  the  lower  flap,  in  the  direction  of  the  muscular 
fibres,  as  they  make  their  appearance.  In  this  manner  is 
exposed  the  two  most  superficial  muscles  of  the  back,  the 
Trapezius  and  the  Latissimus  Dorsi. 

The  Trapezius  is  a beautiful  broad  muscle,  immediately 
under  the  skin,  covering  the  back  parts  of  the  neck  and 
thorax,  and  extending  from  the  bottom  of  the  latter  to 
the  top  of  the  former.  Its  anterior  edge  above,  is  parallel 
with  the  posterior  edge  of  the  sterno-cleido-mastoideus. 
Its  posterior  edge  is  joined  with  that  of  its  fellow,  and  be- 
low, it  overlaps  in  part  the  latissimus  dorsi. 


300 


OF  THE  TRUNK. 


A View  of  the  Muscles  of  the  Back  as  shown  after  the  re- 
moval of  the  Integuments. 

Fig.  59. 


1. 

2. 

3. 

4. 

5. 

6. 


Occipital  Origin  of  the  Trapezius. 

Stcrno-Cleido-  Mastoideus. 

Middle  of  the  Trapezius. 

Insertion  of  the  Trapezius  into  the  Spine  of  the  Scapula. 
Deltoid. 

Second  Head  of  the  Triceps  Extensor  Cubiti. 


MUSCLES  OF  THE  EACK. 


301 


7.  Its  Superior  Portion. 

8.  Scapular  portion  of  the  Latissimus  Dorsi. 

9.  Axillary  Border  of  the  Pectoralis  Major. 

10.  Axillary  Border  of  the  Pectoralis  Minor. 

11.  Serratus  Major  Antieus. 

12.  lnfra-Spinatus. 

13.  Teres  Minor. 

14.  Teres  Major. 

15.  Middle  of  the  Latissimus  Dorsi. 

16.  External  oblique  of  the  Abdomen. 

1 7.  Gluteus  Medius. 

18.  Gluteus  Minimus. 

19.  Gluteus  Magnus. 

20.  Fascia  Lumborum. 


It  arises  from  the  occipital  protuberance,  and  from  eight 
or  ten  lines,  sometimes  more,  of  the  upper  semicircular 
ridge  of  the  occiput,  by  a tendinous  membrane.  It  arises 
also  tendinously  from  the  five  superior  spinous  processes 
of  the  neck,  through  the  intervention  of  the  Ligamentum 
Nuchae,  and  tendinously  from  the  two  lower  spinous  pro- 
cesses of  the  neck,  and  from  all  of  the  back. 

It  is  inserted  fleshy  into  the  external  third  of  the  clavicle, 
tendinous  and  fleshy  into  the  acromion  process,  and  into 
all  the  spine  of  the  scapula.  Its  fibres  having  a very  ex- 
tended origin,  must  of  course  converge  in  getting  to  these 
insertions ; the  upper  fibres  descend,  the  lower  ascend,  and 
the  middle  are  horizontal. 

It  draws  the  scapula  towards  the  spine. 

In  the  cervical  portion  of  these  muscles,  formed  by  the  ori- 
gins of  both  muscles  united,  is  an  elliptical  expanse  of  tendon, 
lying  over  the  ligamentum  nuchse,  and  extended  on  each 
side.  The  ligamentum  nucha;  itself,  is  a vertical  septum  of 
ligamentous  matter,  extending  from  the  central  line  of  the 
occipital  bone,  to  the  spinous  processes  of  all  the  vertebrse 
of  the  neck.  At  its  upper  part,  where  the  spinous  pro- 
cesses of  the  neck  are  short,  this  membrane  is  very  broad, 
and  divides  completely  the  muscle  of  the  two  sides  of  the 
neck  from  each  other. 

The  Latissimus  Dorsi,  is  situated  under  the  skin  at  the 
lower  part  of  the  back,  so  as  to  cover  its  whole  posterior 
portion.  It  arises  by  a thin,  tendinous  membrane,  from  the 
seven  inferior  spinous  processes  of  the  back,  and  by  a thick 


302 


OF  THE  TRUNK. 


tendinous  expansion  from  all  those  of  the  loins  and  sacrum. 
Its  origin  also  extends  in  this  condition,  along  the  iliac  mar- 
gin of  the  sacrum,  and  from  the  posterior  third  of  the  spine 
of  the  ilium.*  Besides  which  the  latissimus  dorsi  has  three 
or  four  fleshy  heads,  from  the  sides  of  the  three  or  four  in- 
ferior false  ribs,  which  are  interlocked  with  the  inferior 
heads  of  the  obliquus  ext  emus  abdominis. 

From  this  extended  origin  the  fibres  converge,  so  as  to 
form  the  posterior  fold  of  the  axilla,  and  to  terminate  in  a fiat, 
thick  tendon,  of  two  inches  in  breadth,  which  is  inserted 
into  the  lower  part  of  the  posterior  ridge  of  the  bicipital 
groove  of  the  os  humeri.  The  upper  part  of  this  muscle 
passes  over  the  inferior  angle  of  the  scapula,  and  derives 
a fasciculus  of  fibres  from  it. 

Afterwards  the  tendons  of  the  two  adhere  closely,  but 
have  a bursa  between  them,  at  their  termination.  That  por- 
tion of  the  tendon  of  the  latissimus,  wThich  is  continuous  with 
the  kwer  edge  of  its  fleshy  belly,  becomes  uppermost  by  a 
half  spiral  turn  in  the  latter ; while  the  upper  portion  is  by 
the  same  arrangement,  made  lowest.  At  the  place  of  its 
insertion,  it  is  commonly  connected  to  the  Pectoralis  Major. 
The  inferior  margin  of  its  tendon,  detaches  a slip  to  the 
brachial  fascia,  and  the  superior  margin ; another  to  the 
smaller  tuberosity  of  the  os  humeri. 

It  draw’s  the  os  humeri  downwards  and  backwards. 

That  portion  of  its  origin,  which  is  the  tendinous  mem- 
brane, arising  from  the  spinous  processes  of  the  loins,  is  the 
Fascia  Lumborum,  and  is  common  to  the  latissimus,  the  in- 
ternal oblique  and  transversalis  of  the  abdomen,  and  seve- 
ral other  muscles  to  be  mentioned. 

The  origin  of  the  two  latissimi  muscles  conjointly, 
makes  a beautiful  lozenge-shaped  expansion,  occupying  its 
entire  spinal  region  ; the  longest  diameter  is  vertical,  and 
just  over  the  spinous  processes,  the  lateral  diameter  extends 
from  one  crista  of  the  ilium  to  the  other. 

Detach  now,  the  trapezius  from  its  origin  and  turn  it  over 
the  shoulder.  Begin  also  to  detach  the  latissimus  dorsi  from 
its  origin  above,  turning  downwards  the  upper  edge  of  the 

* This  origin  frequently  is  tendinous  at  the  back  part  of  the  ilium, 
and  fleshy  in  front. 


MUSCLES  OF  THE  BACK. 


303 


muscle,  as  the  separation  goes  on.  By  doing  so,  in  a little 
time,  is  brought  into  view  the  upper  edge  of  the 

Serratus  Inferior  Posticus.  The  origin  of  this  mus- 
cle is  inseparably  united  to  that  of  the  latissimus  dorsi  by 
the  fascia  lumborum,  in  order  therefore  to  view  it  properly, 
let  the  fleshy  part  of  the  latissimus  be  detached  from  the 
fascia,  and  we  shall  then  see  that  the  serratus  arises  by  this 
tendinous  membrane,  from  the  two  inferior  spinous  pro- 
cesses of  the  back,  and  the  three  superior  of  the  loins. 

It  is  inserted  by  fleshy  digitations  into  the  under  edges  of 
the  four  inferior  ribs. 

It  draws  the  ribs  downwards,  and  is  an  antagonist  to  the 
diaphragm  in  some  respects,  but  more  particularly  to  the 
serratus  superior  posticus. 

The  removal  of  the  trapezius  above,  brings  into  view 
several  muscles,  the  most  superficial  of  which  are  the  Rhom- 
boid, which  being  twTo  together,  look  very  much  like  one. 

The  Rhomboideus  Minor  is  above  the  other.  It  is  a 
narrow  muscle  which  arises  by  a thin  tendon,  from  the  three 
inferior  spinous  processes  of  the  neck,  and  passing  obliquely 
downwards,  is  inserted  into  the  base  of  the  scapula  opposite 
the  origin  of  its  spine. 

The  Rhomboideus  Major,  arises  also  by  a thin  tendon 
from  the  spinous  processes  of  the  neck,  and  from  the  four 
superior  of  the  back,  and  is  inserted  into  all  the  base  of  the 
scapula  below  its  spine. 

These  muscles  drawr  the  scapula  upwards  and  backwards. 
Detach  them  from  their  origins,  and  vTe  see  next, 

The  Serratus  Superior  Posticus,  arising  by  a thin  ten- 
don from  the  three  inferior  spinous  processes  of  the  neck, 
and  the  two  superior  of  the  back,  and  inserted  into  the  se- 
cond, third,  fourth  and  filth  ribs,  by  tendinous  and  fleshy 
slips,  a little  beyond  their  angles. 

This  muscle  draws  the  ribs  upwards.  A good  view 
of  the  serratus  major  anticus,  where  it  is  inserted  into  the 
base  of  the  scapula,  and  of  its  situation  between  the 
thorax  and  scapula,  is  obtained  at  this  stage  of  the  dissec- 


304 


OF  THE  TRUNK. 


tion.  The  muscle  itself,  in  consequence  of  arising  on  the 
anterior  lateral  parts  of  the  thorax,  has  been  considered  in 
the  remarks  preliminary  to  the  study  of  that  cavity. 

Between  the  two  Serrati,  is  an  aponeurotic  expansion 
described  by  Rosenmuller,  which  connects  them  with  each 
other,  and  has  induced  some  anatomists  to  consider  them 
as  but  one  muscle.  It  is  thin  and  diaphanous  ; but  has  the 
fibrous  structure  very  apparent,  and  running  in  a transverse 
direction,  from  the  spinous  processes  to  the  angles  of  the 
ribs.  The  superior  margin  of  the  latissimus  dorsi,  also  runs 
into  this  fascia,  so  as  to  render  its  own  bounds  somewhat 
undefined.  This  fascia,  along  with  the  ribs  and  vertebra?, 
forms  that  canal  in  which  are  contained,  the  deep  seated 
muscles  of  the  back. 

The  Levator  Scapula,  is  placed  between  the  posterior 
edge  of  the  sterno-cleido-mastoideus  and  the  anterior  of  the 
trapezius;  its  lowrer  end  is  just  above  the  Rhomboideus 
Minor.  It  arises  by  rounded  tendons  from  the  three,  four 
or  five  superior  transverse  processes  of  the  neck,  between 
the  scaleni  muscles  and  the  splenius  colli. 

It  is  inserted  fleshy,  into  that  paid  of  the  base  of  the  sca- 
pula, which  is  above  the  margin  of  its  spine.  As  its  name 
expresses,  it  draws  the  scapula  upwards.  A good  view  of 
this  muscle,  may  be  obtained  in  the  front  dissection  of  the 
neck. 

The  Splenius  muscle  comes  next ; its  inferior  extremity 
is  under  the  serratus  superior  posticus,  but  the  principal 
part  of  it  is  covered  by  the  trapezius.  It  arises  from  the 
spinous  processes  of  the  five  inferior  cervical  and  of  the  four 
superior  dorsal  vertebrae. 

It  is  inserted  into  the  back  of  the  mastoid  process  and  a 
small  part  of  the  adjacent  portion  of  the  os  occipitis,  and 
also  into  the  transverse  processes  of  the  two  superior  cervi- 
cal vertebrae.  It  is  customary  to  consider*  the  part  which 
goes  to  the  head  as  Splenius  Capitis,  and  the  paid  below  as 
Splenius  Colli;  the  latter  in  that  case,  is  said  to  arise  from 
the  third  and  fourth  dorsal  vertebrae.  It  draws  the  head 
and  neck  backwards. 


* Albimus,  lox.  cit. 


C~i  £»  CO 


MUSCLES  OF  THE  BACK. 


305 


\ ie w of  the  Second  Layer  of  the  Muscles  of  the  Back. 


Fig.  60. 


1.  Trapezius. 

2.  A portion  of  the  tendinous  ellipse  formed  by  the  Trapezius  on 
both  sides. 

. Spine  of  the  Scapula. 

. Latissimus  Dorsi. 

. Deltoid. 

6.  Infra-Spinatus  and  Teres  Minor. 

7.  External  Oblique  of  the  Abdomen. 

8.  Gluteus  Medius. 

9.  Gluteus  Magnus  of  each  side. 

HI.  Levator  Scapulae. 

1 1.  Rhnmboideus  Minor. 

12.  Rhomboideus  Major. 


20 


30G 


OF  THE  TRUNK. 


13.  Splenius  C pitis. 

14.  Splenius  Colli. 

15.  A portion  of  the  Origin  of  the  Latissiraus  Dorsi. 

16.  Serratus  Inferior  Posticus. 

17.  Supra-Spinatus. 

18.  Infra-Spinatus. 

19.  Teres  Minor. 

20.  Teres  Major. 

21.  Long  Head  of  the  Triceps  Extensor  Cubiti. 

22.  Serratus  Major  Anticus 

23.  Internal  Oblique  of  the  Abdomen. 

Between  the  spinous  processes  of  the  vertebra  and  the 
angles  of  the  ribs,  on  either  side,  there  is  a deep  fossa  filled 
up  entirely  by  muscles,  some  of  them  large  and  powerful. 
The  most  striking  are  the  Sacro-Lumbalis  and  the  Longissi- 
mus  Dorsi. 

The  Sacro-Lumbalis  and  Longissimus  Dorsi,  have  a 
common  origin  from  the  back  of  the  pelvis  and  of  the  lum- 
bar vertebra,  and  extend  to  the  top  of  the  thorax.  They 
arise,  tendinous  posteriorly,  and  fleshy  anteriorly,  from  the 
posterior  surface  of  the  sacrum,  by  its  external  margin  and 
spinous  processes;  they  arise,  also  tendinously  from  the 
spinous  processes,  and  fleshy,  from  the  ends  of  the  trans- 
verse processes  of  all  the  vertebra  of  the  loins,  and  chiefly 
tendinously,  from  the  posterior  part  of  the  spine  of  the 
ilium.  From  the  under  surface  of  this  common  belly,  two 
tendinous  and  fleshy  heads  are  inserted  into  the  inferior 
edge  of  the  transverse  process  of  each  lumbar  vertebra,  the 
smaller  near  its  root,  and  the  larger  near  its  extremity.  On 
a level  with  the  lowest  rib,  and  indeed,  somewhat  below 
it,  a fissure  occurs  in  the  muscle  which  divides  it  into  its 
two  parts. 

The  Longissimus  Dorsi  is  nearest  the  spine  ; it  is  inserted 
by  small  double  tendons,  proceeding  from  its  internal  sur- 
face, into  the  ends  of  the  transverse  processes  of  all  the  verte- 
bra of  the  back,  except  the  first.  It  also,  from  its  outer 
edge,  sends  long  slender  tendons  by  which  it  is  inserted 
into  the  under  edges  of  all  the  ribs  beyond  their  tubercles, 
except  the  two  inferior. 

The  Sacro-Lumbalis  is  inserted  from  its  outer  edge,  into 


MUSCLES  OF  THE  BACK. 


307 


all  the  ribs  at  their  angles,  by  long  and  thin  tendons,  which 
are  successively  longer,  the  higher  they  are  inserted. 

By  turning  over  this  muscle  from  the  other,  towards  the 
ribs,  one  may  see  coming  from  the  eight  lower  ribs,  as  many 
slips,  which  run  into  the  under  surface  of  the  sacro-lumba- 
lis ; they  are  the  Musculi  Accessorii  ad  Sacro-Lumbalem. 

These  two  muscles  keep  the  spine  erect,  and  draw  down 
the  ribs. 

Between  the  ends  of  the  spinous  processes  and  the  edge 
of  the  longissimus  dorsi,  is  a muscle  almost  entirely  tendi- 
nous, and  scarcely  to  be  distinguished  from  the  latter,  both 
in  consequence  of  its  close  connexion  with  it  and  of  its  in- 
significant size.  At  its  lower  part,  it  is  absolutely  a portion 
of  the  longissimus,  and  can  be  separated  from  it  only  by  a 
forced  division.  It  is  a mere  string,  lying  along  the  sides 
of  the  spinous  processes,  and  is  called  from  its  origin  and 
insertion,  the  Spinalis  Dorsi. 

The  Spinalis  Dorsi  arises  tendinously  from  the  spinous 
processes  of  the  two  superior  lumbar,  and  of  the  three  in- 
inferior dorsal  vertebra,  and  is  inserted  tendinously  into  the 
spinous  processes  of  the  nine  superior  dorsal  vertebra,  ex- 
cept the  first. 

It  tends  to  keep  the  spine  erect.  Turn  now  the  splenius 
from  its  insertions,  and  we  shall  see  several  muscles 
under  it. 

The  Cervicalis  Descendens,  is  a small  muscle  placed  at 
the  upper  portion  of  the  thorax,  between  the  insertions  of  the 
sacro-lumbalis  and  of  the  longissimus  dorsi,  into  the  up- 
per ribs ; it  looks,  at  first,  very  much  like  a continuation  or 
appendix  of  the  first,  running  to  the  cervical  vertebra. 

This  muscle  arises  from  the  upper  edges  of  the  four  su- 
perior ribs  by  long  tendons;  it  forms  a small  belly,  which 
is  inserted  into  the  transverse  processes  of  the  fourth,  fifth, 
and  sixth  vertebra  of  the  neck,  between  the  levator  scapula! 
and  splenius  colli,  by  three  distinct  tendons. 

It  draws  the  neck  backwards. 

The  Transversalis  Cervicis,  is  on  the  inner  side  of  the 
last  and  in  contact  with  it,  being  about  the  same  size,  and 


308 


OF  THE  TRUNK. 


having  very  much  the  same  course  and  appearance.  It  is 
considered  as  an  appendage  to  the  longissimus  dorsi. 

It  arises  from  the  transverse  processes  of  the  five  supe- 
rior dorsal  vertebrae,  by  distinct  tendons,  and  forms  a nar- 
row fleshy  belly,  which  is  inserted  by  distinct  tendons  also, 
into  the  transverse  processes  of  the  five  middle  cervical 
vertebrae.  It  draws  the  head  backwards. 

The  Trachelo-Mastoideus,  is  at  the  inner  side  of  the 
last  muscle,  in  contact  with  it. 

It  arises  by  distinct  tendinous  heads,  from  the  transverse 
processes  of  the  three  superior  vertebrae  of  the  back,  and  of 
the  five  inferior  of  the  neck,  and  is  inserted  by  a thin  ten- 
don, into  the  posterior  edge  of  the  mastoid  process. 

The  dorsal  origins  are  frequently  deficient  or  irregular. 
It  draws  the  head  backwards. 

The  Complexus,  a fine,  large  muscle,  is  situated  at  the 
inner  face  of  the  trachelo-mastoideus,  and  is  readily  recog- 
nised by  showing  itself  between  the  bellies  of  the  two 
splenii  capitis,  just  below  the  occiput.  A quantity  of  ten- 
dinous matter  exists  in  its  middle,  which  gives  it  the  com- 
plicated appearance  from  whence  its  name  is  derived. 

It  arises  by  tendinous  heads,  from  the  seven  superior 
dorsal,  and  the  four  inferior  cervical  vertebra  by  their  trans- 
verse processes ; also  by  a fleshy  slip  from  the  spinous  pro- 
cess of  the  first  dorsal.  It  is  inserted  into  the  inferior  part 
of  the  os  occipitis,  bv  the  surface  between  the  upper  and 
lower  semicircular  ridges,  and  on  the  outside  of  the  vertical 
ridge,  which  exists  in  the  middle  of  the  bone. 

It  draws  the  head  backwards. 

The  Semi-Spinalis  Colli,  is  a muscle  which  passes  ob- 
liquelyr  from  transverse  to  spinous  processes,  and  is  situated 
between  the  complexus  and  the  multifidus  spinae ; the 
course  of  its  fibres  renders  it  difficult  to  be  distinguished 
from  the  latter. 

It  arises  from  the  transverse  processes  of  the  six  upper 
vertebra  of  the  back,  by  tendons  which  are  involved  with 
those  of  the  adjacent  muscles,  and  passes  up  the  neck,  to 
be  inserted  into  the  sides  of  the  spinous  processes  of  the 
five  middle  cervical  vertebra. 

It  extends  the  neck  obliquely  backwards. 


MUSCLES  OF  THE  BACK. 


309 


The  Semi-Spinalis  Dorsi  is  lower  down  on  the  spine,  and 
with  difficulty  distinguished  from  the  multifidus  spinae. 
Like  the  last,  it  passes  from  transverse  to  spinous  pro- 
cesses, and  lies  under  the  longissimus  dorsi,  between  it  and 
the  multifidus. 

This  muscle  arises  by  tendons  connected  with  those  of 
the  other  muscles,  from  the  transverse  processes  of  the 
seventh,  eighth,  ninth,  and  tenth  dorsal  vertebrae,  and 
passes  obliquely  upwards  to  be  inserted,  tendinously,  into 
the  sides  of  the  spinous  processes  of  the  two  lower  cervical, 
and  five  upper  dorsal  vertebrae. 

It  draws  the  spine  obliquely  backwards. 

The  Multifidus  Spinje  lies  under  the  muscles  as  yet 
mentioned,  close  to  the  bones  of  the  spine ; in  order  to  see 
it  well,  they  therefore,  should  all  be  cut  away. 

It  has  its  commencement,  tendinous  and  fleshy,  on  the 
back  of  the  sacrum,  being  connected  to  its  spinous  processes 
and  posterior  surface,  also  to  the  back  part  of  the  spine  of  the 
ilium.  It  there  forms  a belly  of  sufficient  magnitude,  to  fill 
up  much  of  the  cavity  between  the  spines  of  the  sacrum  and 
the  posterior  part  of  the  ilium.  It  arises  also  from  the  roots 
of  the  oblique  and  transverse  processes  of  all  the  vertebrae 
of  the  loins,  of  the  back,  and  of  the  four  inferior  of  the 
neck. 

The  multifidus  is  inserted,  tendinous  and  fleshy,  into  the 
roots  and  sides  of  the  spinous  processes  of  all  the  vertebrae, 
of  the  loins,  of  the  back,  and  of  the  five  inferior  of  the 
neck. 

This  muscle  consists  of  a great  number  of  small  bellies, 
which  are  parallel  to  each  other,  each  arising  from  a 
transverse  or  oblique  process,  and  going  to  the  spinous 
process  either  of  the  first  or  second  vertebra  above  it. 

It  twists  the  spine  backwards  and  keeps  it  erect. 

Between  the  head,  and  the  first  and  second  vertebrae, 
and  between  the  latter  two,  there  are  on  each  side,  four 
small  muscles,  intended  for  the  motion  of  these  parts  upon 
each  other.  They  are  brought  into  view  by  the  removal  of 
the  complexus. 

The  Rectus  Capitis  Posticus  Major,  arises  tendinous 


310 


OF  THE  TRUNK. 


and  fleshy,  from  the  extremity  of  the  spinous  process  of  the 
vertebra  dentata,  and  is  inserted  into  the  inferior  transverse, 
or  semicircular  ridge  of  the  os  occipitis,  and  into  a part  of 
the  surface  of  bone  below  it. 

Its  shape  is  pyramidal,  the  apex  being  below.  It  turns 
the  head,  and  also  draws  it  backwards. 

The  Rectus  Capitis  Posticus  Minor,  is  at  the  internal 
edge  of  the  first.  It  arises  tendinous  from  the  tubercle  on 
the  back  part  of  the  first  vertebra,  and  is  inserted  into  the 
internal  end  of  the  inferior  semicircular  ridge  of  the  os  oc- 
cipitis, and  into  part  of  the  surface  between  it  and  the  fora- 
men magnum. 

It  is  also  pyramidal,  with  the  apex  downwards.  It  draws 
the  head  backwards. 

The  Obliquus  Capitis  Superior,  arises  from  the  trans- 
verse process  of  the  first  cervical  vertebra,  and  is  inserted 
into  the  outer  end  of  the  inferior  semicircular  ridge  of  the 
os  occipitis,  behind  the  posterior  part  of  the  mastoid  pro- 
cess and  beneath  the  splenius  muscle. 

It  draws  the  head  backwards. 

The  Obliquus  Capitis  Inferior,  arises  from  the  side  of 
the  spinous  process  of  the  vertebra  dentata,  and  is  inserted 
into  the  back  part  of  the  transverse  process  of  the  first  verte- 
bra of  the  neck. 

It  rotates  the  first  vertebra  on  the  second. 

The  Inter-Spinales  are  small  short  muscles,  placed  be- 
tween the  spinous  processes  of  contiguous  vertebrae.  In 
the  neck  they  are  double,  in  consequence  of  its  spinous 
processes  being  bifurcated ; in  the  back  they  are  almost  en- 
tirely tendinous;  in  the  loins  they  are  single  and  well 
marked. 

They  draw  the  spinous  processes  together,  and  keep  the 
spine  erect. 

The  Inter- Transversarii,  are  also  short  muscles,  placed 
in  a similar  manner  between  the  transverse  processes  of  the 
vertebras.  In  the  neck  they  are  double,  in  the  back  they 


MUSCLES  OF  THE  BACK. 


311 


are  small,  tendinous,  and  not  well  marked;  and  in  the  loins 
they  are  single  and  readily  seen. 

They  draw  the  transverse  processes  together,  and  will 
of  course,  bend  the  spine  to  one  side. 


A View  of  the  Muscles  of  the 
Back,  which  fill  up  the  Fossa 

ON  EITHER  SIDE  OF  THE  SPINOUS 

Processes  of  the  Vertebra. 

1.  Tendinous  Origin  of  the  Longissi- 

mus  Dorsi. 

2.  Upper  portion  of  the  Sacro-Lnmbalis. 

3.  Upper  portion  of  the  Longissimns 

Dorsi. 

4.  Spinalis  Dorsi. 

5.  Cervicalis  Descendens. 

6.  Transversalis  Cervicis. 

7.  Trachelo-Mastoideus. 

8.  Complexus. 

9.  Insertion  of  the  Transversalis  Cer- 

vicis. 

10.  Semi. Spinalis  Dorsi. 

11.  Semi-Spinalis  Cervicis. 

12.  Rectus  Capitis  Posticus  Minor. 

13.  Rectus  Capitis  Posticus  Major. 

14.  Obliquus  Capitis  Superior. 

15.  Obliquus  Capitis  Inferior. 

16.  Multifidus  Spince  at  its  Lower  part. 

The  rest  is  concealed  by  other 
Muscles. 

17.17.  Levatores  Costarum. 

18.  Inter-Transversarii. 

19.  Quadratus  Lumborum. 


Fig.  61. 


The  Levatores  Costarum,  are  small  muscles  concealed 
by  the  sacro-lumbalis,  and  longissimus  dorsi,  and  pass  from 
the  transverse  processes  of  the  last  cervical,  and  the  eleven 
superior  dorsal  vertebrae,  to  the  upper  edges  of  the  next  ribs. 
They  are  twelve  on  either  side  of  the  spine,  and  are  tendinous 
in  their  origins  and  insertions,  with  intermediate  muscular 
bellies. 


312 


OF  THE  TRUNK. 


The  upper  ones  are  small  and  thin,  and  they  increase  in 
magnitude  as  they  descend.  From  the  inferior  edge  of 
nearly  all  these  muscles,  a fleshy  slip  is  detached,  which 
passes  over  the  rib  next  below  its  origin,  to  the  second  rib 
below,  and  occasionally  to  the  third.  These  slips  are 
called  Levatores  Costarum  Longiores.  The  others  which 
descend  from  the  transverse  process,  to  the  rib  next  below, 
are  called  Levatores  Costarum  Breviores. 

These  muscles  are  parallel  in  their  obliquity,  with  the 
external  intercostals,  and  are  not  very  obviously  separated 
from  them.  They  perform  the  same  service,  that  of  ele- 
vating the  ribs. 

The  Rotatores  Dorsi,  of  Professor  Theile  of  Bern,  pass 
from  the  transverse  process  of  a vertebra  below,  to  the 
under  margin  of  the  arch  of  the  vertebra  above.  They  are 
eleven  in  number  on  each  side,  beginning  at  the  second 
dorsal  vertebra,  and  ending  at  the  twelfth.  It  may  be  con- 
sidered as  questionable,  whether  any  advantage  will  arise 
to  descriptive  anatomy,  by  thus  separating  from  the  Multi- 
fidus  Spinse,  fasciculi  heretofore  considered  a part  of  it,  but 
which  Professor  Theile  says,  are  marked  off  by  a layer  of 
cellular  tissue.  As  much  may  be  said  at  least,  of  all  the 
numerous  strips  making  up  the  multifidus  spinae. 


PART  III 


OF  THE  EXTREMITIES. 
CHAPTER  I. 

OF  THE  UPPER  EXTREMITIES. 


SECTION  I. 

Of  the  Fascia. 

The  muscles  of  each  upper  extremity,  are  invested  by 
an  aponeurotic  membrane,  called  the  Fascia  Brachialis, 
which  extends  from  the  shoulder  to  the  hand.  It  begins  at 
the  base  and  spine  of  the  scapula,  the  margin  of  the  acro- 
mion process,  the  acromial  extremity  of  the  clavicle,  and 
from  the  cellular  membrane  in  the  arm-pit,  and  extends 
itself  over  all  the  muscles  of  the  dorsum  of  the  scapula,  and 
over  the  deltoid  muscle.  The  tendons  of  the  latissimus 
dorsi,  and  pectoralis  major,  each  send  off  from  their  mar- 
gins an  expansion  which  is  lost  in  it.  Below  the  spine  of 
the  scapula,  it  is  strong  and  well  marked ; but  on  the  del- 
toid muscle,  as  well  as  on  the  muscles  of  the  arm,  its  des- 
moid character  is  by  no  meajis  so  well  developed.  Above 
the  condyles  of  the  humerus,  the  Fascia  Brachialis  sends 
down  to  the  bone,  a strong  tendinous  partition  to  each 
ridge,  and  which  runs  the  length  of  the  latter,  from  its 
upper  end  to  the  condyle.  These  processes  separate  the 
muscles  on  the  back  of  the  arm,  from  such  as  are  on  the 
front  of  it,  and  are  sometimes  called  the  Ligamentum  Inter- 


OF  THE  UPPER  EXTREMITIES. 


Musculare  Internum,  and  Externum.  They  afford  origin  to 
many  muscular  fibres.  At  the  bend  of  the  elbow,  the  fascia 
brachialis  is  joined  by  a fasciculus  of  tendinous  matter,  from 
the  ulnar  margin  of  the  tendon  of  the  biceps  flexor  cubit;, 
and  which,  in  the  contraction  of  the  muscle,  will  keep  the 
fascia  tense.  At  the  lower  extremity  of  the  fore-arm,  the 
transverse  fibres,  after  diminishing  sensibly,  become  more 
numerous,  and  by  their  attachments  to  the  several  ridges 
on  the  back  of  the  radius  and  of  the  ulna,  form  the  Liga- 
mentum  Carpi  Dorsale.  This  ligament  is  extended  from 
the  styloid  or  outer  margin  of  the  radius,  transversely  to  tne 
styloid  or  inner  margin  of  the  ulna,  to  the  pisiform  bone, 
and  to  the  fifth  metacarpal. 

The  Fascia  Brachialis  affords  origin  in  part,  to  the  mus- 
cles on  the  dorsum  of  the  scapula  below  its  spine ; on  the 
arm  it  is  not  so  intimately  connected  with  the  muscles,  but 
on  the  fore-arm  they  again  begin  to  arise  in  part  from  it. 
In  its  whole  course,  partitions  constituting  the  sheaths  of 
the  muscles,  and.  which  consist,  for  the  most  part,  of  common 
cellular  and  adipose  membrane,  go  from  it  down  to  the 
periosteum  and  interosseous  ligament.  It  adheres  very 
tightly  to  the  ulna,  from  the  olecranon  to  the  styloid  process, 
and  on  its  cutaneous  surface,  are  found  all  the  superficial 
veins,  nerves,  and  lymphatics  of  tire  arm. 

It  is  unnecessary  to  undertake,  from  the  first,  a regular 
dissection  of  this  fascia,  inasmuch  as  it  will  be  gradually 
exposed  in  proceeding  with  the  muscles. 

The  Upper  Extremity  is  most  conveniently  studied  by  de- 
taching it  from  the  trunk,  talcing  care  to  leave  the  clavicle 
with  the  former. 


SECTION  II. 

Of  the  Muscles  of  the  Shoulder. 

The  Muscles  situated  on  the  shoulder  are  six  in  number; 
they  extend,  for  the  most  part,  from  the  scapula  to  the  head 
and  neck  of  the  os  humeri. 

1.  The  Deltoides  is  situated  just  beneath  the  skin,  and 


MUSCLES. 


315 


forms  the  cushion,  which  protects  and  gives  rotundity  to 
the  shoulder  joint.  It  arises  from  the  inferior  edge  of  the 
whole  spine  of  the  scapula,  from  the  circumference  of  the 
acromion  process,  and  from  the  exterior  third  of  the  cla- 
vicle. Its  origin,  for  the  most  part,  is  tendinous  and  fleshy 
mixed ; but  at  its  posterior  part  it  is  entirely  tendinous. 

It  is  inserted  by  a tendinous  point,  into  the  triangular 
rough  surface  on  the  outer  side  of  the  os  humeri,  near  its 
middle.  Its  general  configuration  is  triangular,  and,  when 
spread  out,  its  upper  margin  being  opposed  to  the  inser- 
tion of  the  trapezius,  is  much  more  extensive  than  one 
would  suppose.  Its  fibres  do  not  converge  regularly  to  its 
insertion  like  the  radii  of  a circle;  but  the  whole  muscle  is 
divided  into  several  parts,  between  which,  the  interposi- 
tion of  intermuscular  tendons  affects  the  course  of  the  fibres, 
makes  several  portions  of  the  deltoid  look  penniform,  and 
others  like  smaller  deltoids  introduced  into  the  larger. 

The  deltoid  covers  the  insertion  of  the  pectoralis  major, 
latissimus  dorsi,  and  teres  major,  besides  that  of  the  other 
muscles  of  the  shoulder.  It  also  conceals  the  origin  of  the 
biceps  flexor  cubiti,  and  of  the  coraco-brachialis.  Its  in- 
sertion is  between  the  triceps  extensor  and  the  biceps  flexor, 
and  above  the  origin  of  the  brachialis  internus. 

It  raises  the  os  humeri  to  a horizontal  line  with  the 
acromion. 

Between  the  superior  edge  of  the  deltoid,  the  acromion 
process,  and  the  subjacent  tendons  on  the  top  of  the  articu- 
lation, there  is  a large  Bursa  Mucosa,  which  is  sometimes 
partitioned  off  into  two. 

The  deltoid  should  now  be  detached  from  its  origin  and 
thrown  down,  in  which  a good  view  of  the  other  muscles 
will  be  obtained. 

2.  The  Supra-Spinatus  Scapula,  arises  fleshy  from  the 
whole  fossa  supra-spinata,  which  it  fills  up,  and  from  its 
margins.  Forwards  it  terminates  in  a thick  robust  tendon, 
closely  connected  with  the  capsular  ligament  of  the  joint, 
and  which  passes  under  the  jugum  formed  by  the  articula- 
tion of  the  acromion  with  the  clavicle. 

It  is  inserted,  tendinously,  into  the  inner  face  of  the  great 
tuberosity  of  the  os  humeri,  fit  raises  the  arm,  and  turns 
it  outwards. 


316 


OF  THE  UPPER  EXTREMITIES. 


3.  The  Infra-Spinatus  Scapula,  arises  fleshy,  from  all 
that  portion  of  the  dorsum  scapulae  below  its  spine,  from 
the  spine  as  far  as  the  cervix,  and  from  the  several  margins 
of  the  fossa  infra-spinata.  Its  fibres  pass  obliquely  to  a mid- 
dle tendon,  which  adheres  closely  to  the  capsular  ligament, 
and  goes  under  the  projection  of  the  acromion. 

This  tendon  is  inserted  into  the  middle  facet  of  the 
greater  tuberosity  of  the  os  humeri. 

The  infra-spinatus  rolls  the  os  humeri  outwards  and  back- 
wards. There  is  a bursa  between  its  tendon  and  the 
scapula. 

4.  The  Teres  Minor,  is  situated  at  the  inferior  margin 
of  the  infra-spinatus,  in  the  fossa  of  the  inferior  costa  scapu- 
las, and  looks  very  much  like  a part  of  the  infra-spinatus, 
to  which  it  occasionally  adheres  so  closely,  as  to  be  sepa- 
rated with  difficulty,  it  arises  fleshy,  from  the  whole  of  the 
fossa,  and  from  the  margins  of  the  inferior  costa,  in  the 
space  from  the  cervix  of  the  bone,  to  within  an  inch  or  so 
of  its  inferor  angle. 

It  is  inserted,  tendinous  and  fleshy,  into  the  outer  facet 
of  the  great  tuberosity  of  die  os  humeri,  just  below  the  in- 
fra-spinatus. 

It  draws  the  os  humeri  downwards  and  backwards,  and 
rotates  it  outwards. 

5.  The  Teres  Major,  is  situated  at  the  inferior  edge  of 
the  teres  minor.  It  arises  fleshy  from  the  posterior  surface 
of  the  angle  of  the  scapula,  and  from  a small  part  of  its  in- 
ferior costa ; the  interstice  between  it  and  the  teres  minor  is 
considerable. 

It  is  inserted  by  a broad  tendon,  into  the  internal  ridge 
of  the  groove  of  the  os  humeri,  along  with  the  tendon  of  the 
latissimus  dorsi.  Then-  tendons  at  first,  are  closely  united, 
but  afterwards  there  is  an  intermediate  cavity  lubricated 
with  synovia.  The  tendon  of  the  latissimus  dorsi  is  ante- 
rior, and  the  lower  edge  of  the  teres  extends  further  down 
the  arm,  than  that  of  the  other. 

It  rolls  the  os  humeri  inwards,  and  draws  it  downwards 
and  backwards. 

• 

6.  The  Subscapularis,  occupies  all  the  thoracic  surface 


MUSCLES. 


317 


of  the  scapula,  being  between  it  and  the  serratus  major  an- 
ticus.  It  arises  fleshy  from  the  whole  base,  superior  and 
inferior  costa,  and  costal  surface  of  the  scapula ; it  is  di- 
vided into  several  columns  which  look  somewhat  like  dis- 
tinct muscles,  but  which  all  terminate,  in  a thick  robust  ten- 
don, that  adheres  to  the  inferior  surface  of  the  capsular  liga- 
ment. 

This  tendon  is  inserted  into  the  lesser  tuberosity  of  the  os 
humeri.  The  subscapularis  rolls  the  bone  inwards  and 
draws  it  downwards.  Between  it  and  the  neck  of  the  sca- 
pula, there  is  a bursa,  which,  as  mentioned,  communicates 
with  the  articulation. 


SECTION  III. 

Of  the  Muscles  of  the  Jinn. 

The  Muscles  of  the  Arm  are  five  in  number,  three  ante- 
rior, and  two  posterior. 

1.  The  Biceps  Flexor  Cubiti,  is  situated  immediately 
beneath  the  fascia  and  integuments,  and  forms  the  swell  so 
obvious  in  the  middle  front  part  of  the  arm.  It  arises  by 
two  heads.  The  first  called  the  long,  is  a round  tendon, 
which  comes  from  the  superior  extremity  of  the  glenoid 
cavity  of  the  scapula,  passes  through  the  shoulder  joint,  and 
through  the  groove  of  the  os  humeri ; the  second  or  short 
head  arises,  tendinously,  from  the  extremity  of  the  coracoid 
process  of  the  scapula,  in  company  with  the  coraco-brachia- 
lis  muscle.  The  fleshy  bellies  in  which  these  tendons 
terminate,  unite  with  each  other,  a few  inches  below  the 
shoulder  joint,  to  form  a common  muscle.  At  first,  they 
are  only  connected  by  loose  cellular  substance,  but  about 
half-way  down  the  arm,  they  are  inseparably  united. 

The  biceps  terminates  below  in  a flattened  oval  tendon, 
and  passes  in  front  of  the  elbowT  joint,  to  be  inserted  into  the 
posterior  rough  part  of  the  tubercle  of  the  radius.  A bursa 
mucosa  is  placed  between  the  tendon  and  the  front  of  the 
tubercle,  the  surface  of  the  latter  being  covered  with  carti- 


318 


OF  THE  UPPER  EXTREMITIES. 


lage.  From  the  ulnar  side  of  this  tendon,  proceeds  a 
fascia,  running  into  that  of  the  fore-arm. 

The  relative  position  of  the  biceps  is  as  follows.  Its  long 
head  is  first  within  the  cavity  of  the  capsular  ligament,  and 
then  between  the  tendons  of  the  latissimus  dorsi  and  pecto- 
ralis  major,  where  it  is  bound  down  by  strong  ligamentous 
fibres.  The  tendon  below  is  superficial,  and  may  be  easily 
felt  by  flexing  the  extremity ; but  its  insertion  dips  down 
between  the  pronator  teres  and  supinator  radii  longus. 

This  muscle  flexes  the  fore-arm. 

2.  The  Coraco-Brachialts,  is  situated  on  the  upper  inter- 
nal side  of  the  arm,  at  the  inner  edge  of  the  short  head  of 
the  biceps  muscle,  with  which  it  is  connected  for  three  or 
four  inches.  It  arises  tendinously  and  fleshy,  from  the 
middle  facet  of  the  point  of  the  coracoid  process  of  the 
scapula,  in  common  with  the  short  head  of  the  biceps 
muscle. 

It  is  inserted,  tendinous  and  fleshy,  into  the  internal  side 
of  the  middle  of  the  os  humeri,  by  a rough  ridge,  just  be- 
low the  tendons  of  the  latissimus  dorsi,  and  teres  major, 
and  in  front  of  the  brachialis  externus,  or  third  head  of  the 
triceps.  From  the  lower  end  of  this  muscle  there  proceeds 
to  the  internal  condyle  of  the  os  humeri,  an  intermuscular 
ligament,  which  separates  the  brachialis  interims,  from  the 
third  head  of  the  triceps. 

This  muscle  draws  the  arm  upwards  and  forwards. 

3.  The  Brachialis  Internus,  is  situated  immediately  be- 
neath the  biceps,  and  is  concealed  by  it,  excepting  the 
outer  edge.  It  has  a bifurcated  fleshy  origin  from  the  mid- 
dle front  face  of  the  os  humeri,  on  each  side  of  the  inser- 
tion of  tire  deltoid,  and  its  origin  is  continued  fleshy  from 
this  point  downwards,  from  the  whole  front  of  the  bone,  to 
within  a very  small  distance  of  its  articular  surface. 

It  is  inserted  by  a strong  short  tendon,  into  the  rough 
surface  at  the  root  of  the  coronoid  process  of  the  ulna.  A 
bursa  sometimes  exists  between  the  tendon  of  the  brachialis 
internus,  that  of  the  biceps,  supinator  brevis,  and  the  elbow 
joint. 

The  brachialis  flexes  the  fore-arm,  and  by  pass  ng  in 
front  of  the  elbow  joint,  strengthens  the  latter  very  much. 


MUSCLES. 


319 


Its  lower  part  lies  under  the  tendon  of  the  biceps,  and  be- 
tween the  pronator  teres  and  the  supinator  longus. 

4.  The  Triceps  Extensor  Cubiti,  forms  the  whole  of 
the  fleshy  mass  on  the  back  of  the  arm ; it  therefore  oc- 
cupies the  space  between  the  integuments  and  the  bone. 
It  arises  by  three  heads.  The  first,  called  Longus,  comes, 
by  a flattened  tendon,  from  a rough  ridge  on  the  inferior 
edge  of  the  cervix  scapulae.  The  second,  called  the  Brevis, 
arises,  by  a sharp,  tendinous  and  fleshy  beginning,  from  a 
slight  ridge  on  the  outer  back  part  of  the  os  humeri,  just 
below  its  head.  The  third  head,  called  Brachialis  Exter- 
nus,  arises,  by  an  acute  fleshy  beginning,  from  the  inner 
side  of  the  os  humeri,  near  the  insertion  of  the  teres,  major. 
This  muscle,  both  at  its  external  and  internal  edge,  is  sepa- 
rated from  the  muscles  in  the  front  of  the  arm,  by  the  inter- 
muscular ligamentous  septum,  which  arises  near  the  middle 
of  the  os  humeri,  and  runs  to  its  condyles.  The  whole 
back  of  the  os  humeri,  as  well  as  the  posterior  surface  of 
these  intermuscular  septa,  is  occupied  by  the  origin  of  the 
triceps.  The  muscular  fibres  run  in  various  directions  ac- 
cording to  their  respective  heads  and  places  of  origin. 

At  the  inferior  end  of  the  muscle  is  found  a broad  tendon, 
which  covers  its  posterior  face.  This  tendon  is  inserted 
into  the  base  or  back  part  of  the  olecranon,  and  into  the 
ridge  leading  down  the  ulna  on  its  radial  side. 

The  triceps  extends  the  fore-arm.  Its  bellies  unite  above 
the  middle  of  the  os  humeri,  but  the  interstices  between  them, 
may  be  observed  much  lower  down. 

There  is  a bursa  between  the  tendon,  and  the  olecranon 
process;  besides  which,  there  is  sometimes  another  on  each 
side  of  the  first. 

Connected  with  the  last,  is  a muscle  which  should  be  dis- 
sected at  the  same  time,  as  it  has  corresponding  functions, 
and  looks  very  much  like  an  appendage  of  the  triceps ; it 
is  the 

5.  Anconeus.  This  is  a small  triangular  muscle  just  be- 
neath the  skin,  at  the  outer  posterior  part  of  the  elbow  joint. 
It  arises  tendinous  from  the  posterior  lower  part  of  the  exter- 
nal condyle  of  the  os  humeri,  adheres  to  the  capsular  liga- 


320 


OF  THE  UPPER  EXTREMITIES. 


ment  of  the  joint,  and  is  partly  covered  by  the  tendon  of  the 
triceps. 

It  is  inserted  fleshy,  and  thin,  into  the  ridge  on  the  outer 
part  of  the  head  of  the  ulna,  leading  from  the  olecranon, 
and  fills  up  the  triangular  depression  found  there. 

It  extends  the  fore-arm. 


SECTION  IV. 

Of  the  Muscles  of  the  Fore-Arm. 

There  are  eight  muscles  on  the  front  of  the  Fore-Arm, 
which  arise  from  the  inner  condyle  of  the  os  humeri,  and  from 
the  ridge  leading  to  it,  and  are,  either  directly  or  indirectly, 
Flexors  of  the  fore-arm  and  hand.  This  fact  should  be  im- 
pressed on  the  mind  of  the  student,  as  it  simplifies  much  the 
act  of  committing  them  to  memory.  The  systematic  treatises 
of  anatomy  describe  the  origin  of  each  muscle,  as  if  it  were 
totally  distinct  from  the  rest ; the  student  will  soon  coirect 
the  error  arising  from  this,  and  learn  that  the  heads  ol-  all 
these  muscles  are  connected  to  contiguous  heads,  by  adhe- 
sion and  by  inter-muscular  ligaments,  and  that  there  would 
be  almost  as  much  propriety  in  describing  them  as  having 
a common  origin,  as  there  is  in  considering  them  so  insu- 
lated. 

Of  the  eight  muscles  situated  on  the  front  of  the  fore-arm, 
some  are  superficial  and  others  deep-seated. 

1.  The  Pronator  Radii  Teres,  is  just  beneath  the  fascia 
of  the  fore-arm,  and  forms  the  radial  side  of  the  muscles  of 
the  internal  condyle.  It  arises  fleshy  from  the  anterior  face 
of  the  internal  condyle  of  the  os  humeri,  and  tendinous 
from  the  coronoid  process  of  the  ulna.  It  passes  very 
obliquely  across  the  fore-arm  at  the  internal  edge  of  the 
brachialis  internus  muscle  and  is 

Inserted,  tendinous  and  fleshy,  into  the  external  back 
part  of  the  radius  just  below  the  insertion  of  the  supinator 


MUSCLES. 


321 


radii  brevis,  occupying  thereby  about  two  inches  ot  the 
middle  of  the  bone. 

It  rolls  the  hand  inwards. 

2.  The  Flexor  Manus  vel  Carpi  Radialis,  is  placed  at 
the  ulnar  side  of  the  last  muscle,  and  is  also  superficial. 
It  arises  by  a narrow  tendon,  from  the  lower  front  part  of 
the  internal  condyle  of  the  os  humeri ; fleshy  from  the  in- 
termuscular ligaments,  the  brachial  fascia,  and  the  upper 
part  of  the  ulna.  It  forms  a thick,  fleshy  belly,  terminating 
below  in  a tendon,  which  passes  under  the  anterior  annular 
ligament  of  the  wrist,  and  runs  through  a groove  in  the  os 
trapezium. 

It  is  inserted,  tendinous,  into  the  base  of  the  metacarpal 
bone  of  the  fore-finger,  in  front,  and  there  is  a bursa  between 
the  lower  extremity  of  its  tendon  and  the  trapezium.  The 
tendon  is  there  held  down  by  ligamentous  fibres. 

It  bends  the  hand  and  draws  it  towards  the  radius. 

3.  The  Palmaris  Longus  is  at  the  ulnar  side  of  the 
flexor  carpi  radialis,  and  is  superficial.  Sometimes  it  does 
not  exist.  It  is  a small  short  muscle  terminating  in  a long 
slender  tendon,  and  arises  by  a small  tendon  from  the  in- 
ternal condyle,  and  fleshy  from  the  intermuscular  ligament 
on  each  of  its  sides. 

It  is  inserted,  tendinous,  into  the  upper  margin  of  the 
ligamentum  carpi  annulare  anterius,  near  the  root  of  the 
thumb,  and  a division  of  its  tendon  passes  on  to  the 
aponeurosis  palmaris. 

It  bends  the  hand,  and  makes  tense  the  palmar  aponeu- 
rosis. 

4.  The  Flexor  Manus  vel  Carpi  Ulnaris,  occupies 
among  the  superficial  muscles,  the  ulnar  side  of  the  fore- 
arm. It  arises  tendinous,  from  the  internal  condyle  of  the 
os  humeri;  fleshy,  from  the  upper  internal  side  of  the  ole- 
cranon, and  by  a tendinous  expansion  which  is  part  of  the 
fascia  of  the  fore-arm,  from  the  ridge  at  the  internal  side  of 
the  ulna,  to  within  three  or  four  inches  of  the  wrist. 

It  is  inserted  into  the  upper  side  of  the  os  pisiforme  by  a 
round  tendon,  which  begins  high  up  at  the  radial  margin  of 
the  muscle,  and  into  which  the  muscular  fibres  run.  Some- 
21 


322 


OF  THE  UPPER  EXTREMITIES. 


times  the  tendon  is  continued  over  the  os  pisiforme,  so  as 
to  be  likewise  inserted  into  the  base  of  the  metacarpal  bone 
of  the  little  finger.  There  is  a loose  bursa  at  the  junction 
of  the  tendon  with  the  pisiforme  bone. 

It  bends  the  hand  and  draws  it  towards  the  ulna. 

Fig.  62. 

A View  of  the  Outer  Layer  of  the  Mus. 

CLES  ON  THE  FRONT  OF  THE  FoRE-ARM 

(Flexors.) 

•I.  Lower  portion  of  the  Biceps  Flexor  Cubiti. 

2.  Brachialis  Internus. 

3.  Lower  Internal  portion  of  the  Triceps. 

4.  Pronator  Radii  Teres. 

5.  Flexor  Carpi  Radialis. 

G.  Palmaris  Longus. 

7.  Part  of  the  Flexor  Sublimis  Digitorum. 

8.  Flexor  Carpi  Ulnaris. 

9.  Palmar  Fascia. 

10.  Palmaris  Brevis  Muscle. 

11.  Abductor  Pollicis  Manus. 

12.  Portion  of  the  Flexor  Brevis  Pollicis  Manus. 
The  Line  crosses  the  Adductor  Pollicis. 

13.  Supinator  Longus. 

14.  Extensor  Ossis  Metacarpi  Pollicis. 

5.  The  Flexor  Digitorum  Sublimis  Perforate,  is 
Concealed  very  much  by  the  muscles  just  enumerated  in 
Consequence  of  being  placed  between  them,  do  get  a 
good  view  of  its  origin,  they  all  should  be  cut  away  Irom 
the  os  humeri.  It  arises,  tendinous  and  fleshy,  trom  the 
internal  condyle  of  the  os  humeri;  tendinous  from  the  coro- 
noid  process  of  the  ulna,  and  fleshy,  from  the  tubercle  of  the 
radius;  the  latter  part  of  its  origin  being  extended  obliquely 


MUSCLES. 


323 


tendinous,  for  three  or  four  inches  along  that  line  of  the 
radius  which  is  at  the  insertion  of  the  pronator  teres.  With 
these  origins,  the  muscle  spreads  over  the  front  of  the  fore- 
arm at  its  upper  part,  from  the  radial  to  the  ulnar  margin. 

From  the  lower  end  of  the  muscle,  arise  four  distinct 
tendons,  which  commence  much  above  the  wrist,  go  beneath 
its  anterior  ligament,  and  having  reached  the  palm  of  the 
hand,  diverge  to  the  several  fingers.  To  each  finger,  a 
tendon  is  appropriated,  which  passes  in  front  of  the  meta- 
carpal bone  to  the  phalanges,  and  after  having  split  into 
two,  is  inserted  into  the  angle  formed  by  the  junction  of 
the  cylindrical  and  flat  surfaces  of  the  second  phalanx, 
near  the  middle. 

It  bends  the  second  phalanges  on  the  first;  its  action 
may  also  be  continued  so  as  to  clench  the  hand  and  to  bend 
it  on  the  arm. 

6.  The  Flexor  Digitorum  Profundus  Perforans,  is 
beneath  the  flexor  sublimis'  and  the  flexor  ulnaris.  It 
arises  fleshy  from  the  oblong  concavity  of  the  ulna  between 
the  coronoid  and  the  olecranon  processes ; fleshy  from  the 
lower  margin  of  the  base  of  the  coronoid  process;  from  the 
ulnar  portion  of  the  interosseous  ligament;  and  from  the 
front  of  the  upper  two-thirds  of  the  ulna. 

The  tendons  of  this  muscle  are  different  from  those  of  the 
other;  they  commence  in  front  of  it,  like  a tendinous  mem- 
brane, which  is  gradually  divided  into  several  fasciculi,  ad- 
heringto  each  other  by  cellular  membrane.  The  fasciculated 
character  of  the  tendons  is  still  preserved  when  they  go 
under  the  anterior  carpal  ligament,  and  until  they  begin  to 
disperse  as  distinct  tendons  to  each  of  the  fingers. 

Each  tendon,  going  in  front  of  its  metacarpal  bone  and 
of  the  corresponding  phalanges,  gets  through  the  slit  in  the 
flexor  sublimis,  and  is  inserted  into  the  front  part  of  the 
base  of  the  third  phalanx  of  the  finger. 

It  bends  the  last  joint  of  the  fingers,  and  by  increased 
action,  may  flex  the  hand  like  the  preceding  muscle. 

7.  The  Flexor  Longus  Pollicis  lies  in  front  of  the 
radius,  but  beneath  the  flexor  sublimis.  It  arises,  by  an 
acute  fleshy  beginning,  from  the  radius  just  below  its  tuber- 
cle; also,  fleshy,  from  the  middle  two-thirds  of  the  front  of 


324 


OF  THE  UPPER  EXTREMITY. 


the  bone,  and  from  the  radial  portion  of  the  interosseous 
ligament.  The  body  of  the  muscle  is  joined  by  a small 
fleshy  slip,  having  a tendinous  origin  from  the  internal 
condyle  of  the  os  humeri. 

On  the  ulnar  margin  of  this  muscle  a tendon  is  formed 
early,  to  which  the  fibres  pass  obliquely.  This  tendon  goes 
under  the  annular  ligament  of  the  wrist,  through  the  fossa 
formed  in  the  short  flexor  muscle  of  the  thumb,  and  be- 
tween the  sesamoid  bones,  to  be  inserted  into  the  base  of 
the  second  phalanx  of  the  thumb.  From  the  inferior  end 
of  the  fore-arm,  to  the  middle  of  the  first  phalanx,  the  ten- 
don is  invested  by  its  appropriate  bursa. 

It  bends  the  last  joint  of  the  thumb. 

Fig.  63. 


A View  of  the  Under  Layer  of  Mus- 
cles on  the  Front  of  the  Fore- Arm 
(Flexors.) 

1.  Internal  Lateral  Ligament  of  the  Elbow- 

Joint. 

2.  Capsular  Ligament  of  the  Elbow-Joint. 

3.  Coronary  Ligament  of  the  Head  of  the 

Radius. 

4.  Flexor  Profundus  Digitorum  Performs. 

5.  Flexor  Longus  Pollicis. 

6.  Pronator  Quadratus. 

7.  Adductor  Pollicis  Manus. 

8.  Lumbricales. 

9.  Interossei. 


MUSCLES. 


325 


While  performing  this  dissection,  there  are  several  minu- 
tiae which  deserve  attention.  The  Annular  Ligament  of 
the  wrist  in  front,  is  a very  strong  membrane  passing  across 
the  carpus,  from  the  projection  of  the  scaphoides  and  tra- 
pezium on  the  radial  side  of  the  wrist,  to  the  unciform  pro- 
cess on  the  ulnar  side,  and  to  the  cuneiform  and  pisiform 
bones.  Between  it  and  the  concavity  of  the  carpus,  an 
oval  foramen  is  formed  for  transmitting  the  tendons  of  the 
several  flexors. 

These  tendons  as  they  pass  under  the  anterior  annular  li- 
gament of  the  wrist  are  surrounded  by  the  superior  Bursa 
Mucosa.  It  begins  about  an  inch  and  a half  above  the  ra- 
dio-carpal articulation,  and  extends  to  the  lower  margin  of 
the  annular  ligament.  It  adheres  to  its  circumference  to 
this  ligament,  and  to  the  capsule  of  the  joint;  within,  it  sends 
in  a considerable  number  of  processes,  whereby  each  tendon 
is  surrounded  and  connected  to  the  adjoining  tendons ; 
while,  at  the  same  time,  no  restraint  is  put  upon  the  natural 
motions  of  the  part.  In  its  texture  this  bursa  resembles  a 
dense  elastic  cellular  membrane.  In  addition  to  this,  the 
flexor  tendons  as  they  pass  from  the  root,  to  the  extremity 
of  each  finger,  are  surrounded  by  a synovial  bursa,  which 
by  its  secretion  continually  lubricates  them,  and  permits 
them  to  play  freely  backwards  and  forwards,  according  to 
the  flexions  and  extensions  of  the  fingers.  These  mucous 
or  synovial  sheaths,  begin  a little  distance  above  the  first 
joint  of  the  finger,  adhere  there  to  both  flexor  tendons,  and 
extend  to  about  the  middle  of  the  last  phalanx.  They  give 
to  the  tendons  a very  polished  lubricated  surface ; are  re- 
flected over  the  anterior  flat  faces  of  the  phalanges,  being 
separated  from  them  by  a small  quantity  of  adipose  matter; 
are  also  reflected  over  the  anterior  faces  of  the  capsular 
ligaments,  and  line  the  vaginal  ligaments. 

The  Vaginal  Ligaments  of  the  fingers  (Ligamenta  Vagi- 
nalia)  bind  down  the  flexor  tendons,  and  keep  them  applied 
to  the  fronts  of  the  phalanges.  They  are  of  the  same  ex- 
tent from  above  downwards,  with  the  mucous  sheaths 
just  mentioned,  and  are  stretched  between  the  ulnar,  and 
the  radial  margins  of  the  phalanges.  The  fibres  of  which 
they  consist,  pass  for  the  most  part  transversely,  and  are  of 
a fibro-cartilaginous  character.  These  fibres  diminish  in 


326 


OF  THE  UPPER  EXTREMITIES. 


number  towards  the  end  of  each  finger,  and  are  stronger  on 
the  fore  finger  than  on  any  of  the  others.  In  front  of  the  first 
joints,  or  metacarpo-phalangial  articulations,  and  the  pha- 
langial  articulations,  the  vaginal  ligaments  are  much  thinner 
than  elsewhere,  in  order  to  permit  the  free  flexion  of  the 
fingers.  The  structure  indeed,  at  these  points  is  decidedly 
marked  off  by  its  diminished  thickness;  and  though  the 
course  of  the  fibres  is  the  same  from  side  to  side,  yet  some 
anatomists  have  thought  it  worth  while  to  designate  it  par- 
ticularly under  the  name  of  Annuli  Juncturarum  Ligamen- 
tosi. 

Within  the  Vaginal  Ligaments,  small  tendinous  ffsena 
arise  from  the  first  and  second  phalanges;  they  vary  in 
number  ha  different  individuals,  and  run  obliquely  for- 
wards, some  to  terminate  in  the  flexor  profundus  ten- 
dons, and  others  in  those  of  the  flexor  sublimis : they  are 
called  Vincula  Accessoria,  and  are  covered  by  a reflection 
of  the  synovial  sheath.  Indeed,  they  seem  to  be  formed 
almost  entirely  from  the  latter. 

We  may  also  observe  that  in  front  of  each  joint,  in- 
dependently of  the  swelling  of  the  articular  extremities  of 
the  bones,  the  capsular  ligament  is  thickened  by  an  addi- 
tion of  cartilaginous  matter,  by  which  a trochlea  is  formed. 
This  trochlea  facilitates  the  sliding  of  the  tendons  by  its 
smoothness,  and  the  flexions  of  the  phalanges  by  removing 
the  tendons  farther  from  the  axis  of  motion,  after  the  same 
manner  with  the  patella. 

8.  The  Proxator  Quadratus,  is  just  above  the  carpal 
surfaces  of  the  radius  and  ulna,  and  between  the  other  mus- 
cles and  the  bone.  In  the  adult  it  is  about  two  inches 
wide,  and  its  fibres  run  across  the  fore-arm.  It  arises, 
fleshy  and  tendinous,  from  the  ridge  at  the  inner  surface  of 
the  ulna  near  its  lower  extremity,  and  from  the  front  of  the 
bone. 

It  is  inserted  into  the  corresponding  front  surface  of  the 
radius. 

It  rotates  the  radius  inwards. 


MUSCLES. 


327 


OF  THE  MUSCLES  ON  THE  BACK  OF  THE 
FORE-ARM. 

These  muscles  are  ten  in  number.  They  arise  for  the  most 
part  from  the  external  condyle  and  the  ridge  leading  to  it, 
and  are  Extensors  either  of  the  fore-arm  or  of  the  fingers  and 
thumb.  Then'  origins  are  less  blended  with  each  other 
than  those  of  the  flexor  muscles,  nevertheless  between  se- 
veral of  them,  there  are  intermuscular  ligaments  which  con- 
nect them  closely.  They  are  superficial  and  deep  seated. 

1.  The  Supinator  Radii  Longus  is  situated  along  the 
radial  edge  of  the  fore-arm,  immediately  beneath  the  integu- 
ments. It  arises,  fleshy  and  tendinous,  from  the  higher  part 
of  the  ridge  leading  to  the  external  condyle,  commencing 
just  below  the  insertion  of  the  deltoid  muscle,  and  being 
here  placed  between  the  brachialis  internus  and  the  outer 
head  of  the  triceps.  It  forms  a thick,  fleshy  belly,  consti- 
tuting the  external  margin  of  the  arm  about  the  elbow  joint, 
and  terminates  near  the  middle  of  the  radius,  in  a flat 
tendon. 

It  is  inserted  by  the  latter,  into  a small  rough  ridge 
on  the  outer  side  of  the  radius,  just  above  its  styloid 
process. 

It  rolls  the  radius  outwards. 

2.  The  Extensor  Carpi  Radialis  Longior,  is  situated 
beneath  the  former  muscle.  It  arises,  tendinous  and  fleshy, 
from  the  space  of  the  external  ridge  of  the  os  humeri  be- 
tween the  supinator  longus  and  the  external  condyle.  It  forms 
a short,  fleshy  belly,  which  terminates  in  a flat  tendon  above 
the  middle  of  the  radius. 

It  is  inserted,  by  this  tendon  into  the  posterior  part  of  the 
root  of  the  metacarpal  bone  of  the  fore-finger  near  the 
thumb. 

The  tendon  of  this  muscle  is  surrounded  by  a synovial 
sheath,  at  the  place  where  it  passes  the  lower  end  of  the  ra- 
dius, under  the  posterior  carpal  ligament.  Another  bursa 
also  exists  at  the  insertion;  which,  on  one  occasion,  I found 
so  much  enlarged  in  a young  woman,  as  to  require  its  extir- 
pation. The  operation  was  fully  successful. 

It  extends  the  hand. 


328 


OF  THE  UPPER  EXTREMITIES. 


3.  The  Extensor  Carpi  Radialis  Brevior,  is  beneath  the 
last,  but  projects  somewhat  beyond  it.  It  arises,  tendinous, 
from  the  posterior  and  lower  part  of  the  external  condyle, 
and  from  the  external  lateral  ligament  of  the  elbow  joint. 
It  forms  a thick,  fleshy  belly,  placed  along  the  radius, 
and  which  terminates  in  a flat  tendon  about  the  middle  of 
that  bone. 

Its  tendon,  becoming  rounded,  is  inserted  into  the  poste- 
rior part  of  the  base  of  the  metacarpal  bone  of  the  second 
finger. 

It  extends  the  hand. 

4.  TheExTENSOR  Carpi Ulnaris is  superficial,  andplaced 
principally  parallel  with  the  ulna.  It  arises,  tendinous, 
from  the  external  condyle,  and  fleshy,  from  the  intermuscular 
ligament  and  inside  of  the  fascia.  Crossing  very  obliquely 
the  upper  part  of  the  radius  and  the  ulna,  it  also  arises 
fleshy  from  the  back  part  of  the  latter  bone.  Its  fibres  ter- 
minate obliquely  in  a tendon  which  goes  through  the  groove 
of  the  ulna,  and  is  there  furnished  with  a bursa. 

It  is  inserted,  by  its  tendon,  into  the  ulnar  side  of  the 
base  of  the  metacarpal  bone  of  the  little  finger. 

It  extends  the  hand. 

5.  The  Extensor  Digitorum  Communis  is  superficial, 
being  placed  between  the  extensor  ulnaris  and  the  extensor 
radialis  brevior.  It  arises,  tendinous,  from  the  external  con- 
dyle, and  fleshy,  from  the  intermuscular  ligament  of  the 
contiguous  muscles.  As  it  approaches  the  wrist,  it  sends 
off  four  tendons,  which  pass  together  through  a common 
groove  on  the  back  of  the  radius.  On  the  back  of  the  hand 
these  tendons  diverge,  and  near  the  roots  of  the  fingers  send 
cross  slips  to  each  other. 

Each  tendon  goes  to  its  respective  finger,  and  covers  the 
whole  posterior  part  of  it,  being  spread  out  into  a membrane, 
which  adheres  to  the  phalanges  from  the  root  of  the  first,  to 
the  root  of  the  last.  The  precise  mode  of  the  insertion  of 
these  tendons,  is  as  follows:  on  the  back  of  the  first  phalanx, 
the  lateral  margins  of  these  tendons,  are  joined  by  the  ten- 
dons of  the  lumbricales  and  interossei,  and  the  tendinous 
membrane  thus  formed,  simply  adheres  by  condensed  cellular 
membrane,  to  the  whole  back  of  the  first  phalanx ; the  mid- 


MUSCLES. 


329 


die  part  of  this  tendon  then  passes  on,  to  be  inserted  near 
the  articular  margin  of  the  base  of  the  second  phalanx,  and 
the  two  lateral  parts  of  the  tendinous  membrane,  after  keep- 
ing separate  for  some  distance,  unite  and  are  jointly  inserted 
into  the  back  of  the  base  of  the  third  phalanx. 

Fig.  64. 


A View  of  the  Outer  Layer  of  Mus- 
cles on  the  Back  of  the  Fore-Arm 
(Extensors.) 

1.  Lower  portion  of  the  Biceps  Flexor. 

2.  Part  of  the  Brachialis  Internus. 

3.  Lower  part  of  the  Triceps  Extensor. 

4.  Supinator  Radii  Longus. 

5.  Extensor  Carpi  Radialis  Longior. 

6.  Extensor  Carpi  Radialis  Brevior. 

7.  Tendinous  Insertions  of  these  two  Mus- 

cles. 

8.  Extensor  Communis  Digitorum. 

9.  Portion  of  the  Extensor  Communis  Digi- 

toruin  called  Aurioularis. 

10.  Extensor  Carpi  Ulnaris. 

11.  Anconeus. 

12.  Portion  of  the  Flexor  Carpi  Ulnaris. 

13.  Extensor  Minor  Pollicis.  The  Muscle 

nearest  the  Figure  is  the  Extensor 
Ossis  Metacarpi  Pollicis. 

14.  Extensor  Major  Pollicis. 

15.  Posterior  Annular  Ligament.  The  di=- 

tribution  of  the  Tendons  of  the  Ex- 
tensor Communis,  is  seen  on  the  backs 
of  the  fingers. 


The  section  of  this  muscle  appropriated  to  the  little  finger 
has  a distinct  appearance,  and  frequently  its  tendon  goes 
through  a distict  fossa  in  the  radius,  from  which  causes  it 
has  obtained  the  name  of  Auricularis. 

A bursa  invests  these  tendons  at  the  wrist,  as  they  pass 
through  their  groove,  and  is  single  above;  but  in  following 
the  course  of  the  tendons,  like  them  it  divides,  and  follows 
each  tendon  respectively  to  the  base  of  the  first  phalanx. 


330 


OF  THE  UPPER  EXTREMITIES. 


This  muscle  extends  all  the  joints  of  the  fingers,  being 
the  antagonist  of  the  flexors. 

6.  The  Supinator  Radii  Brevis,  can  only  be  well  seen 
by  detaching  the  origins  of  the  aforesaid  muscles;  it  will  then 
be  found  in  contact  with  the  radius,  making  a close  in- 
vestment of  its  head  and  upper  third.  It  arises,  tendinous, 
from  the  external  condyle  of  the  os  humeri,  and  tendinous 
and  fleshy,  from  the  ridge  which  descends  from  the  coro- 
noid  process,  on  the  posterior  radial  edge  of  the  ulna. 

Its  fibres  surround,  obliquely,  the  upper  external  part  of 
the  radius,  and  are  inserted  into  its  tubercle,  and  into  the 
oblique  rough  ridge,  corresponding  with  the  upper  margin 
of  the  pronator  teres.  At  the  interstice  between  the  radius 
and  ulna,  near  the  anterior  edge  of  this  muscle,  a fleshy 
slip  is  occasionally  seen,  which  passes  from  the  radial  side 
of  the  coronoid  process  to  the  ulnar  edge  of  the  radius. 

This  muscle  rotates  the  radius  outwards. 

7.  The  Extensor  Ossis  Metacarpi  Pollicis  Manus, 
arises  fleshy,  from  the  posterior  part  of  the  ulna  immediately 
below  the  anconeus,  from  the  interosseous  ligament,  and  from 
the  back  part  of  the  radius  just  below  the  insertion  of  the 
supinator  brevis.  It  terminates  in  a round  tendon,  which 
passes  over  the  tendons  of  the  radial  extensors,  and  through 
a groove  on  the  styloid  side  of  the  lower  end  of  the 
radius,  and  is  there  invested  by  a bursa. 

It  is  inserted,  by  its  tendon,  into  the  base  of  the  meta- 
carpal bone  of  the  thumb,  and  into  the  external  side  of  the 
trapezium. 

It  extends  the  metacarpal  bone  of  the  thumb. 

8.  The  Extensor  Minor  Pollicis  Manus,  is  at  the  ulnar 
side  of  the  last  muscle.  It  arises,  tendinous,  from  the  back 
of  the  ulna  below  its  middle,  and  fleshy  from  the  interosse- 
ous ligament.  It  adheres  to  the  radius,  and  terminates  in 
a tendon  which  passes  through  a groove  in  the  styloid  side 
of  the  radius  along  with  the  last  named  muscle. 

It  is  inserted  into  the  first  phalanx  of  the  thumb  by  its 


MUSCLES. 


331 


tendon,  which  is  extended  to  the  root  of  the  second  pha- 
lanx. 

It  extends  the  first  phalanx. 

9.  The  Extensor  Major  Pollicis  Manus,  arises  by  a 
small  tendinous,  and  extensive  fleshy  origin,  from  the  back 
of  the  ulna  above  its  middle,  and  from  the  interosseous 
ligament ; also  from  the  back  of  the  radius ; it  terminates 
near  the  wrist  in  a tendon,  which  passes  through  a groove 
on  the  back  of  the  radius  near  the  ulna.  The  belly  of  this 
muscle  conceals,  very  much,  the  other  extensors  of  the 
thumb. 

It  is  inserted,  by  its  tendon,  into  the  oblong  transverse 
tubercle  on  the  back  of  the  base  of  the  second  phalanx  of 
the  thumb.  Its  tendon  is  furnished  with  one  synovial 
sheath  at  the  inferior  extremity  of  the  radius,  which  extends 
to  the  carpus ; and  another,  which  is  smaller  and  placed 
upon  the  carpus  and  upon  the  base  of  the  first  metacarpal 
bone. 

It  extends  the  second  phalanx. 

The  tendons  of  the  last  two  muscles  are  much  connected 
with  each  other,  and  are  spread  in  the  form  of  a membrane 
on  the  back  of  the  thumb,  after  the  manner  of  the  extensor 
tendons  of  the  fingers. 

10.  The  Indicator  is  a small  muscle  on  the  back  of  the 
ulna,  concealed  by  the  extensor  communis  and  extensor 
ulnaris.  It  arises,  tendinous  and  fleshy,  from  the  back  of 
the  ulna,  commencing  near  its  middle,  and  from  the  con- 
tiguous part  of  the  interosseous  ligament.  It  terminates  in 
a tendon,  which  goes  through  the  same  fossa  with  the  ex- 
tensor communis;  it  afterwards  is  joined,  about  the  head 
of  the  first  phalanx,  to  the  tendon  of  the  common  extensor 
belonging  to  the  fore-finger. 

With  the  tendon  of  the  extensor  communis,  it  is  inserted 
along  the  back  of  the  fore-finger  to  the  base  of  the  third 
phalanx. 

It  extends  the  fore-finger. 

At  this  stage  of  the  dissection  it  is  proper  to  notice  the 
Posterior  Carpal  Ligament,  which  passes  from  the  side  of 
the  radius  to  the  side  of  the  ulna.  It  is  two  inches  in 


332 


OF  THE  UPPER  EXTREMITIES. 


breadth,  and  seems  to  be  a continuation  of  the  fascia  of  the 
fore-arm.  It  will  be  found  strongly  attached  to  the  different 
ridges  of  the  radius  and  ulna,  and  from  its  want  of  elasticity, 
perfectly  adapted  to  prevent  the  tendons  from  springing 
out  of  their  respective  grooves.  It  forms  one  jugum  for 
the  first  two  extensors  of  the  thumb,  another  for  the  radial 
extensors  of  the  hand,  a third  for  the  tendon  of  the  third 
extensor  of  the  thumb,  a fourth  for  the  indicator  and  ex- 
tensor communis,  and  a fifth  for  the  extensor  ulnaris. 


OF  THE  SMALL  MUSCLES  OF  THE  HAND. 

The  skin  and  fat  being  carefully  removed  from  the  palm 
of  the  hand,  we  bring  into  view  the  Aponeurosis  Palmaris. 
This  is  a triangular  tendinous  membrane  which  covers  all 
the  hollow  of  the  hand,  and  is  spread  over  its  muscles.  It 
arises  from  the  anterior  carpal  ligament  somewhat  narrow; 
it  then  spreads  out,  and  dividing  into  four  sections,  is  fixed 
to  the  heads  of  the  metacarpal  bones.  Each  section  bifur- 
cates, to  allow  the  flexor  tendons  to  pass  to  the  fingers,  and 
is  united  to  the  contiguous  sections  by  transverse  bands  or 
frcena.  The  muscles  of  the  ball  of  the  thumb  and  of  the 
little  finger,  are  covered  by  a thin  membrane  extended  from 
the  lateral  margins  of  this  aponeurosis. 

The  Palmaris  Brevis,  is  apt  to  be  cut  away  unconscious- 
ly; it  is  just  below  the  skin  at  the  inner  side  of  the  hand. 
It  consists  of  separate  fasciculi  unequally  divided,  and 
arises  from  the  ligament  of  the  wrist,  and  from  the  ulnar 
side  of  the  palmar  aponeurosis. 

It  is  inserted  into  the  skin  and  fat  at  the  inner  margin  of 
the  hand,  and  covers  the  muscles  of  the  little  finger. 

It  contracts  the  skin  of  the  hand. 

The  Aponeurosis  Palmaris  being  removed,  a good  view 
is  obtained  of  the  long  flexor  tendons  and  many  of  the  small 
muscles  of  the  hand. 

The  Lumbricales  are  conspicuous ; they  are  four  in 
number,  of  the  size  and  shape  of  earth  worms.  They  arise, 
tendinous  and  fleshy,  from  the  radial  sides  of  the  tendons 


MUSCLES. 


333 


of  the  flexor  profundus,  beneath  the  ligamentum  carpi 
annulare,  and  a little  beyond  its  anterior  edge. 

They  terminate  in  little  flat  tendons  which  run  along  the 
outer  or  radial  edges  of  the  fingers,  and  are  inserted  into 
the  tendinous  expansion  on  the  back  of  the  first  phalanx  of 
each  finger,  about  its  middle. 

They  bend  the  first  phalanges. 

Four  muscles  constitute  the  ball  of  the  thumb. 

1.  The  Abductor  Pollicis  Manus,  arises  tendinous  and 
fleshy,  from  the  anterior  surface  of  the  ligamentum  carpi 
annulare,  and  from  the  projecting  ends  of  the  trapezium  and 
scaphoides. 

It  is  inserted,  tendinous,  into  the  outer  side  of  the  base 
of  the  first  phalanx  of  the  thumb,  and  into  the  tendinous 
membrane  derived  from  the  extensors  on  its  back  part. 

It  draws  the  thumb  from  the  fingers.  This  muscle  is 
next  to  the  skin. 

2.  The  Opponens  Pollicis  is  beneath  the  abductor,  and 
without  its  removal  can  scarcely  be  seen.  It  arises, 
tendinous  and  fleshy,  from  the  projecting  point  of  the  os 
trapezium  and  from  the  adjacent  part  of  the  annular  liga- 
ment. 

It  is  inserted,  tendinous  and  fleshy,  into  the  radial  edge 
of  the  metacarpal  bone  of  the  thumb,  from  its  base  to  its 
head. 

It  draws  the  metacarpal  bone  inwards. 

3.  The  Flexor  Brevis  Pollicis  Manus,  is  beneath  the 
abductor  pollicis  and  at  the  ulnar  side  of  the  opponens  pol- 
licis. A groove  is  formed  in  it  by  the  tendon  of  the  flexor 
longus  pollicis,  which  divides  it  into  two  heads. 

The  first  head  arises,  fleshy,  from  the  points  of  the  tra- 
pezium, trapezoides,  and  from  the  contiguous  part  of  the 
internal  surface  of  the  annular  ligament,  and  is  inserted  into 
the  outer  sesamoid  bone ; the  sesamoid  bone,  like  a patella, 
being  connected  to  the  first  phalanx  of  the  thumb  by 
tendon. 

The  second  or  internal  head,  arises  fleshy,  from  the 
magnum  and  unciforme,  near  their  metacarpal  surfaces, 
and  from  the  base  of  the  metacarpal  bone  of  the  middle 


334 


OF  THE  UPPER  EXTREMITIES. 


finger.  It  is  inserted  into  the  inner  sesamoid  bone,  which 
* like  the  external,  is  connected,  by  ligament,  to  the  first 
phalanx. 

The  short  flexor,  as  its  name  implies,  bends  the  first  joint 
of  the  thumb. 

4.  The  Abductor  Pollicis  Manus,  lies  in  the  palm  of 
the  hand  beneath  the  lumbricales  and  the  tendons  of  the 
flexor  sublimis  and  profundus.  It  arises,  fleshy,  from  the 
ulnar  edge  of  the  metacarpal  bone  of  the  middle  finger, 
between  its  base  and  head. 

It  is  inserted,  tendinous,  into  the  inner  part  of  the  base 
of  the  first  phalanx  of  the  thumb,  near  the  internal  sesamoid 
bone. 

It  pulls  the  thumb  towards  the  fingers. 

The  Abductor  Indicis  Manus  is  on  the  radial  edge  of 
the  hand,  between  the  metacarpal  bones  of  the  fore-finger 
and  thumb,  and  is  just  beneath  the  skin.  It  arises  ten- 
dinous fiom  the  trapezium,  and  fleshy  from  the  ulnar  edge 
of  the  metacarpal  bone  of  the  thumb,  between  its  base  and 
head. 

Being  placed  along  the  side  of  the  metacarpal  bone  of 
the  fore -finger,  it  is  inserted,  by  a short  tendon,  into  the 
radial  side  of  the  first  phalanx. 

It  draws  the  fore-finger  from  the  others. 

There  are  three  muscles  constituting  the  fleshy  part  of 
the  ulnar  side  of  the  hand,  or  the  ball  of  the  little  finger. 

1.  The  Abductor  Minimi  Digiti  Manus,  is  the  most 
superficial.  It  arises,  fleshy  from  the  protuberance  on  the 
internal  side  of  the  os  pisiforme,  and  from  the  contiguous 
parts  of  the  annular  ligament. 

It  is  inserted,  tendinous,  into  the  ulnar  side  of  the  first 
phalanx  of  the  little  finger,  and  into  the  tendinous  mem- 
brane which  covers  its  back  part. 

It  draws  the  little  finger  from  the  rest. 

2.  The  Flexor  Parvus  Minimi  Digiti  Manus,  is  beneath 
the  abductor.  It  arises  fleshy,  from  the  unciform  process 


MUSCLES. 


335 


of  the  os  unciforme,  and  from  the  contiguous  part  of  the 
annular  ligament. 

It  is  inserted,  tendinous,  into  the  ulnar  side  of  the  base 
of  the  first  phalanx  of  the  little  finger,  being  united  with 
the  tendon  of  the  abductor,  and  with  the  tendinous  mem- 
brane expanded  over  the  back  of  the  finger. 

It  bends  the  little  finger. 

A View  of  the  Muscles  on  the  Palm  of  the  Hand. 

Fig.  65. 

1.  Annular  Lug-ament. 

23.  Origin  and  Insertion  of 
the  Abductor  Pollicis. 

3.  Opponens  Pol  icis. 

4.5.  Two  B Hies  of  the  Flexor 
Brevis  Pollicis. 

6.  Adductor  Pollicis. 

7.7.  Lumbrieales  arising  from 
Tendons  of  tte  Flexor 
Profundus  Digitorum. 

8.  Shows  how  the  Tendon 

of  the  Flexor  Profun- 
dus pass  through  the 
Flexor  Sublimis. 

9.  Tendon  of  ihe  Flexor  Lon- 

gus  Pollicis. 

10.  Abduc'or  Minimi  Diaiti. 

11.  Flexor  Parvus  Minimi  Di- 

gi'i. 

12.  Pisi  orm  Bone. 

13.  First  Dorsal  Interos-eous 

Muscle. 


3.  The  Adductor  Metacarpi  Minimi  Digiti,  is  placed 
beneath  the  abductor  and  flexor,  next  to  the  metacarpal 
bone.  It  arises,  fleshy,  from  the  unciform  process  of  the 
os  unciforme,  and  from  the  contiguous  part  of  the  annular 
ligament  of  the  wrist. 

It  is  inserted,  tendinous  and  fleshy,  into  the  fore  part 
of  the  metacarpal  bone  of  the  little  finger,  from  its  base 
to  its  head. 

It  brings  the  metacarpal  bone  of  the  little  finger  to- 


336 


OF  THE  UPPER  EXTREMITIES. 


wards  the  others,  and  thereby  deepens  the  hollow  of  the 
hand. 

The  Interosseous  Muscles,  fill  up  the  interstices  of  the 
metacarpal  bones;  they  are  seven  in  number,  four  on  the 
palm,  and  three  on  the  back  of  the  hand.  The  back  ones 
arise  by  double  heads  from  the  contiguous  sides  of  two 
metacarpal  bones;  the  palmar  ones  have  each  a single 
head  only,  which  comes  from  the  metacarpal  bone  of  the 
finger,  which  each  interosseous  muscle  is  intended  to  serve. 
As  a general  description  they  all  may  be  said  to  arise, 
fleshy  and  tendinous,  from  the  base  and  sides  of  the  meta- 
carpal bones,  and  to  be  inserted  tendinous,  into  the  sides 
of  the  first  phalanges,  and  into  the  tendinous  membrane 
on  the  backs  of  the  fingers,  derived  from  the  tendons  of 
the  extensor  communis.  The  first  four  are  very  deeply 
seated,  on  the  palm  of  the  hand,  but  the  three  others  are 
on  the  back. 

1.  The  Prior  Indicis,  is  along  the  radial  side  of  the 
first  metacarpal  bone,  or  that  of  the  first  finger,  and  arises 
from  the  base  and  side  of  the  same. 

It  is  inserted,  tendinous,  into  the  radial  side  of  the  first 
phalanx  of  the  fore-finger. 

It  draws  the  fore-finger  towards  the  thumb. 

2.  The  Posterior  Indicis,  is  at  the  ulnar  side  of  the 
first  digital  metacarpal  bone.  It  arises  from  the  base  and 
ulnar  side  of  the  same  bone,  and  is  inserted,  tendinous,  into 
the  ulnar  side  of  the  first  phalanx  of  the  fore-finger. 

It  draws  the  fore-finger  towards  the  others. 

3.  The  Prior  Annularis,  is  at  the  radial  side  of  the  me- 
tacarpal bone  of  the  third  or  ring  finger,  and  arises  from 
the  base  and  radial  side  of  the  said  bone. 

It  is  inserted,  tendinous,  into  the  radial  side  of  the  first 
phalanx  of  the  ring  finger. 

It  draws  that  finger  towards  the  thumb. 

4.  The  Interosseous  Digiti  Auricularis,  is  at  the  ra- 
dial side  of  the  metacarpal  bone  of  the  little  finger,  and 
arises  from  the  radial  side  and  base  of  said  bone. 


MUSCLES. 


337 


It  is  inserted,  tendinous,  into  the  radial  side  of  the  first 
phalanx  of  the  same  finger. 

It  draws  the  little  finger  towards  the  others. 

By  removing  the  tendons  of  the  extensor  communis  from 
the  back  of  the  hand,  we  see  the  three  posterior  or  double- 
headed interosseous  muscles. 

5.  The  Prior  Medii,  is  between  the  metacarpal  bones 
of  the  fore  and  middle  finger,  and  arises  from  the  opposite 
roots  and  sides  of  these  bones. 

It  is  inserted,  tendinous,  into  the  radial  side  of  the  first 
phalanx  of  the  middle  finger. 

It  draws  the  middle  finger  towards  the  thumb. 

6.  The  Posterior  Medii,  is  between  the  metacarpal 
bones  of  the  middle  and  ring  fingers,  and  arises  from  the 
opposite  sides  and  roots  of  these  bones. 

It  is  inserted,  tendinous,  into  the  ulnar  side  of  the  first 
phalanx  of  the  middle  finger. 

It  draws  the  middle  finger  towards  the  little  one. 

7.  The  Posterior  Annularis,  is  between  the  metacarpal 
bones  of  the  ring  and  little  finger,  and  arises  from  the  op- 
posed sides  and  roots  of  these  metacarpal  bones. 

It  is  inserted,  tendinous,  into  the  ulnar  side  of  the  first 
phalanx  of  the  ring  finger. 

It  draws  the  middle,  towards  the  little  finger. 


22 


338 


OF  THE  UPPER  EXTREMITIES. 


SECTION  V. 


Of  the  Blood-  Vessels  of  the  Upper  Extremities. 

The  Arteries  of  the  Upper  Extremity  are  derived  from 
the  subclavian,  the  course  of  which,  to  the  scaleni  muscles, 
is  described  in  the  account  of  the  neck.  The  Subclavian 
passes  over  the  middle  of  the  first  rib,  between  the  scalenus- 
anticus  and  medius  muscles,  and  afterwards  goes  between 
the  first  rib  and  the  subclavius  muscle  to  the  arm-pit. 
Here  it  is  called  Axillary  Artery,  (Arteria  Axillaris ,)  and 
its  position  is  under  the  tendinous  insertion  of  the  pec- 
toralis  minor,  and  almost  touching  it ; it  then  passes,  at  the 
internal  inferior  part  of  the  head  of  the  humerus,  parallel 
with,  and  bordering  on,  the  internal  edge  of  the  coraco- 
brachialis  muscle.  At  the  posterior  fold  of  the  arm-pit,  it 
is  placed  very  near  the  tendon  of  the  latissimus  dorsi,  be- 
tween it  and  the  coraco-brachialis.  Emerging  from  the 
axilla  at  this  place,  its  name  is  changed  into  that  of  Bra- 
chial Artery,  ( Arteria  Brachialis.) 

The  Arteria  Brachialis  descends  the  arm,  at  the  inter- 
nal margin  of  the  lower  part  of  the  coraco-brachialis,  and 
afterwards  at  the  internal  margin  of  the  biceps  flexor  cubiti. 
At  the  bend  of  the  arm  it  is  at  the  inner  edge  of  the  tendon 
of  the  biceps,  and  passes  under  its  aponeurosis  ; and  a little 
below  the  joint  it  generally  splits  into  two  branches  of 
nearly  equal  magnitude,  the  Radial  and  the  Ulnar  Artery, 
although  occasionally  this  division  occurs  much  higher  up 
the  arm,  as  hereafter  stated. 

The  relative  situation  of  this  great  artery  with  the  nerves 
and  veins  of  the  part,  should  be  closely  observed.  Between 
the  scaleni  muscles,  the  majority  of  the  nerves  forming  af- 
terwards the  axillary  plexus,  is  above  and  somewhat  poste- 
rior to  the  subclavian  artery  ; but  when  this  artery  becomes 


BLOOD-VESSELS. 


339 


axillary,  the  nerves  unite  in  various  combinations,  and  sur- 
round it  like  so  many  cords  of  a platted  whip-thong.  The 
axillary  vein  is  below  and  somewhat  in  front  of  the  artery, 
and  very  near  it.  These  several  parts  are  united  by  a loose 
vascular,  adipose  and  cellular  membrane,  containing  many 
lymphatic  glands. 

1.  The  Arteria  Dorsalis  Superior  Scapulas,  varies 
much  in  its  origin;  it  comes  sometimes  from  the  subclavian, 
and  on  other  occasions  from  the  upper  part  of  the  axillary. 
Not  unfrequently  it  is  a branch  of  the  inferior  thyroid.  In 
either  the  first  or  the  last  case,  its  course  is  very  important 
to  the  surgeon,  for  it  runs  along  the  posterior  margin  of  the 
clavicle,  towards  its  acromial  extremity,  and  in  an  opera- 
tion, by  being  opened,  might  be  mistaken  for  the  subclavian 
artery  itself.  When  it  comes  from  the  axillary  artery,  it  is 
tortuous,  and  has  to  ascend  to  its  destination,  being  com- 
pletely out  of  the  way  of  an  operation  from  above,  upon  the 
subclavian  artery.  Its  final  distribution  is  always  the  same, 
for  it  passes  through  the  notch  in  the  upper  costa  of  the 
scapula,  near  the  coracoid  process,  and  there  divides  into 
branches  supplying  the  supra-spinatus  muscle,  the  infra- 
spinatus, and  the  parts  contiguous  to  the  shoulder-joint. 

2.  The  Arteria  Mammarias  Externa,  arise  from  the 
axillary  between  the  subclavius  and  the  pectoralis  minor 
muscles.  They  consist  in  four  principal  branches,  going 
uniformly  to  certain  parts ; but  the  origin  of  these  branches 
varies,  for  sometimes  they  are  originally  distinct  trunks  from 
the  axillary  artery,  and  on  other  occasions  blended  into  one 
or  more.  They  are 

a.  Thoracica  Superior,  distributed  to  the  parts  of  the  pec- 
toralis major  muscle,  just  below  the  clavicle,  some  branches 
going  to  the  pectoralis  minor. 

b.  Thoracica  Longa,  supplying  the  inferior  parts  of  the 
great  pectoral  muscle,  the  mamma  of  the  female,  and  integu- 
ments. 

c.  Thoracica  Acromialis,  making  for  the  fissure  between 


340 


OF  THE  UPPER  EXTREMITIES. 


the  deltoid  and  great  pectoral  muscle,  and  distributed  to 
them  along  the  margins  of  this  fissure,  upwards  and  down- 
wards. 

d.  Thoracica  Axillaris,  very  irregular  in  origin  and  size; 
■when  small  it  is  distributed  generally  to  the  fat  and  glands 
of  the  axilla  ; when  large,  it  is  a trunk  the  size  of  a goose- 
quill,  running  on  the  scapular  surface  of  the  serratus  major 
anticus,  and  distributed  to  it  and  adjacent  muscles  by 
branches  coming  off  at  right  angles. 

3.  The  Scapularis  (Sub-Scapularis)  arises  from  the 
axillary  artery  about  the  anterior  margin  of  the  sub-scapu- 
laris  muscle.  It  passes  downwards  towards  the  angle  of 
the  scapula,  in  contact  with  this  muscle,  and  is  distributed 
to  the  teres  major  and  minor,  sub-scapularis  and  latissimus 
dorsi  muscles. 

A little  below  the  neck  of  the  scapula,  a large  trunk,  the 
Dorsalis  Inferior  Scapulae,  arises  from  the  scapularis,  and 
winds  around  the  bone  to  be  distributed  to  the  infra-spinatus 
and  the  contiguous  muscles,  an  anastomosis  being  formed 
under  the  neck  of  the  acromion  process,  between  the  dorsalis 
inferior  and  superior  scapulae. 

4.  The  Circumflexa  Anterior,  is  a small  artery  about 
the  size  of  a crow-quill.  It  arises  from  the  axillary,  just 
above  the  superior  or  posterior  margin  of  the  tendon  of  the 
teres  major  and  latissimus  dorsi.  It  adheres  closely  to  and 
surrounds  half  the  os  humeri,  just  below  its  head,  going 
between  the  bone  and  the  coraco-brachialis  and  biceps 
muscles,  to  be  distributed  to  the  articulation  and  to  the  con- 
tiguous muscles. 

5.  The  Circumflexa  Posterior  is  much  larger,  and 
arises  from  the  axillary  about  the  same  place  with  the  last, 
but  commonly  a little  below ; sometimes  they  have  a com- 
mon trunk.  It  surrounds  the  back  part  of  the  os  humeri, 
going  between  the  long  head  of  the  triceps  and  the  bone, 
by  passing  between  the  teres  minor  and  major  muscles  in 
the  first  instance.  It  is  distributed  to  the  shoulder  joint 
and  the  contiguous  muscles,  especially  the  deltoid. 


BLOOD-VESSELS. 


341 


6.  The  Profunda  Major  Humeri  or  Spiralis,  arises  from 
the  great  artery  of  the  upper  extremity,  just  below  the  tendon 
of  the  teres  major,  where  the  artery  is  called  Brachial  or 
Humeral.  It  passes  downwards  a little  distance,  and  there 
enters  the  interstice  between  the  first  and  the  third  head  of 
the  triceps  muscle.  It  winds  between  this  muscle  and  the 
bone  very  obliquely  downwards,  and  appears  at  last,  on 
the  outer  side  of  the  arm,  between  the  brachialis  internus 
and  the  supinator  longus ; it  reaches  to  the  external  con- 
dyle. In  this  course  the  profunda  sends  many  branches  to 
the  triceps  and  to  the  contiguous  muscles.  Its  origin  is 
sometimes  from  the  scapular,  or  from  the  posterior  circum- 
flex artery. 

7.  The  Profunda  Minor  is  uncertain  in  its  origin,  but 
comes  commonly  from  the  Brachial,  two  inches  below  the 
last ; sometimes  it  is  a branch  of  the  last.  It  is  distributed 
on  the  internal  surface  of  the  triceps  extensor,  and  extends 
to  the  internal  condyle. 

8.  The  Nutritia,  is  a very  small  branch  from  the  hume- 
ral, arising  near  the  medullary  foramen  of  the  os  humeri, 
which  it  penetrates,  and  is  distributed  to  the  lining  mem- 
brane of  the  bone.  It  is  not  larger  than  a knitting  needle. 

9.  The  Anastomotica  is  a small  branch  from  the  hume- 
ral, arising  about  the  place  where  the  os  humeri  begins  to 
expand  in  order  to  form  the  elbow  joint.  It  passes  on  the 
internal  face  of  the  brachialis  internus  muscle,  and  then 
over  the  ridge  of  the  internal  condyle,  to  the  groove  between 
the  condyle  and  the  olecranon  process,  where  it  anasto- 
moses with  a recurrent  branch  of  the  ulnar  artery. 

Several  arterioles  are  also  sent  from  the  brachial  artery, 
to  the  biceps,  brachialis,  triceps,  and  coraco-brachialis, 
which  are  too  irregular  and  too  small  to  deserve  description. 

The  Brachial  Artery  it  has  been  stated,  is  divided  a 
little  below  the  elbow  joint  into  two  principal  trunks, 
Radial  and  Ulnar.  Sometimes  this  division  is  on  a line 
with  the  joint;  at  other  times  it  occurs  nearer  the  insertion 
of  the  brachialis  muscle.  The  division,  however,  does 


342 


OF  THE  UPPER  EXTREMITIES. 


occasionally  occur,  in  all  the  space  between  the  axilla  and 
the  elbow  joint,  in  which  case  the  radial  artery  sometimes 
is  just  beneath  the  skin  at  the  elbow,  and  continues  un- 
commonly superficial  to  the  wrist. 

The  Radial  Artery  (Arteria  Radialis,)  is  smaller  than 
the  ulnar  and  extends  from  the  elbow  to  the  hand.  In  the 
early  part  of  its  course,  it  is  at  the  bottom  of  the  fissure,  be- 
tween the  pronator  teres  and  the  supinator  radii  longus; 
afterwards  it  crosses  the  insertion  of  the  former,  runs  parallel 
with,  and  in  front  of  the  radius  to  the  wrist,  between  the 
tendons  of  the  supinator  longus  and  of  the  flexor  carpi  radi- 
alis. Below  the  styloid  process  it  gets  between  the  carpus 
and  the  extensors  of  the  thumb,  runs  a little  distance  on  the 
radial  side  of  the  back  of  the  hand,  and  then  penetrates  to 
the  palm  between  the  base  of  the  metacarpal  bone  of  the 
thumb  and  of  the  fore-finger.  It  furnishes  the  following 
branches,  collateral  and  terminating. 

1.  The  Recurrens  Radialis  arises  about  the  neck  of 
the  radius.  It  winds  around  the  joint  externally,  between 
the  external  condjde  and  the  muscles  coming  from  it,  and 
anastomoses  with  the  spiralis  or  profunda  of  the  humeral 
artery;  being  distributed  in  many  collateral  branches,  to  the 
joint  and  contiguous  muscles. 

2.  Several  small  and  irregular  muscular  branches,  arise 
from  the  Radial  artery  in  its  progress  to  the  wrist;  they  have 
no  appropriated  names. 

3.  The  Superficialis  Volje,  arises  from  the  radial  about 
the  inferior  margin  of  the  pronator  quadratus  muscle.  It 
passes  superficially  over  the  process  of  the  trapezium  to  the 
muscles  of  the  ball  of  the  thumb,  and  one  of  its  terminating 
branches  joins  the  arcus  sublimis.  Sometimes  the  super- 
ficialis volae,  is  the  principal  branch  of  the  radial. 

4.  The  Dorsalis  Carpi  arises  from  the  radial,  at  the 
carpus,  runs  transversely  across  the  back  of  the  latter,  and 
detaches  the  posterior  interosseous  arteries  of  the  back  of 
the  hand.  They  anastomose  with  branches  from  the  ulnar, 
and  interosseous  arteries  of  the  fore-arm. 


BLOOD-VESSELS. 


343 


5.  The  Magna  Pollicis,  a terminating  branch  of  the 
radial,  comes  from  it,  in  the  palm  of  the  hand,  just  at  the 
root  of  the  metacarpal  bone  of  the  thumb.  It  runs  beneath 
the  abductor  indicis,  and  at  the  head  of  the  metacarpal  bone 
divides  into  two  branches,  which  go  along  the  sides  of  the 
thumb,  to  its  extremity;  where  they  anastomose  and  termi- 
nate. 

6.  The  Radialis  Indicis,  arising  at  the  same  place  with 
the  latter,  runs  along  the  metacarpal  bone  of  the  fore-finger, 
and  along  the  radial  side  of  the  same  finger  to  its  extremity. 

7.  The  Palmaris  Profunda,  is  the  third  terminating 
branch  of  the  radial  artery.  It  arises  near  the  same  place 
with  the  last  two  ; crosses  the  hand  between  the  metacarpal 
bones  and  the  flexor  tendons,  thus  forming  the  Arcus  Pro- 
fundus, from  which  branches  proceed  to  the  interossei  mus- 
cles, and  which  ends  on  the  ulnar  side  of  the  palm  of  the 
hand,  by  a branch  to  the  Arcus  Superficialis. 

The  Ulnar  Artery,  (Arteria  Ulnaris,)  one  of  the  forks 
of  the  brachial  at  the  elbow,  passes  more  in  a line  with  it 
than  the  radial  artery  does.  Being  deeply  seated,  it  goes, 
immediately  after  its  origin,  under  several  of  the  muscles  of 
the  internal  condyle,  and  between  the  flexor  sublimis  and 
profundus ; getting  from  beneath  the  flexor  sublimis,  it  after- 
wards runs  parallel  with  the  ulna  or  nearly  so,  lying  on  the 
flexor  profundus,  between  the  flexor  ulnaris  and  the  ulnar 
margin  of  the  flexor  sublimis,  and  concealed  two-thirds  of 
the  way  down  the  fore-arm,  by  the  overlapping  of  these  mus- 
cles. At  the  thin  part  of  the  fore-arm,  commonly  called  the 
wrist,  it  is  superficial,  and  maybe  felt  pulsating  in  the  living 
body  at  the  radial  margin  of  the  tendon  of  the  flexor  ulnaris. 

The  ulnar  artery,  at  the  carpus,  takes  a very  different 
course  from  the  radial,  for  it  passes  over  the  anterior  annular- 
ligament  of  the  carpus,  just  at  the  radial  side  of  the  os  pisi- 
forme,  to  which  it  is  held  by  a small  ligamentous  noose,  and 
then  proceeds  to  the  palm  of  the  hand.  Between  the  apo- 
neurosis palmaris  and  the  flexor  tendons,  it  forms  that  curve 
from  the  ulnar  to  the  radial  side  of  the  hand,  called  the  Arcus 
Sublimis.  This  curve  commonly  begins  a little  beyond  the 
anterior  margin  of  the  annular  ligament,  and  presenting  its 


344 


OF  THE  UPPER  EXTREMITIES. 


convexity  forwards,  terminates  about  the  middle  of  the  ball 
of  the  thumb,  at  its  inner  margin. 

The  branches  sent  from  the  Ulnar  artery,  are  as  follow : 

1.  The  Recurrens  Ulnaris  arises  from  the  ulnar  about 
tire  lower  part  of  the  tubercle  of  the  radius,  and  winding 
upwards,  is  distributed  in  small  branches  to  the  muscles  of 
the  internal  condyle.  One  of  its  ramuscules  goes  between 
the  internal  condyle  and  the  olecranon  process,  to  anasto- 
mose with  the  arteria  anastomotica  of  the  humeral. 

2.  The  Interossea,  arises  from  the  ulna  just  below  the 
other.  It  is  a large  trunk,  and  proceeds  but  a little  dis- 
tance, when  it  divides  into  two  principal  branches  called 
Anterior  and  Posterior  Interosseal  arteries. 

a.  The  Interossea  Anterior  is  much  the  larger;  it  runs  in 
contact  with  the  interosseous  ligament  to  the  upper  margin 
of  the  pronator  quadratus,  giving  off  branches  to  the  deep- 
seated  muscles  of  the  fore-arm  in  its  course.  Under  the 
pronator  it  perforates  the  interosseous  ligament,  and  dis- 
tributes to  the  back  of  the  carpus  and  of  the  hand,  branches, 
which  anastomose  witli  branches  of  the  radial  and  posterior 
interosseal. 

b.  The  Interossea  Posterior  is  sometimes  a separate 
trunk,  arising  from  the  ulnar  just  above  the  former.  In 
either  case,  it  soon  perforates  the  interosseous  ligament,  to 
get  to  the  back  of  the  fore-arm.  Here  it  sends  backwards 
a Recurrent  Branch,  (Recurrens  Interossea)  to  the  back  of 
the  elbow,  which  anastomoses  with  the  recurrens  ulnaris 
and  radialis.  It  then  proceeds  downwards,  being  deeply 
seated,  and  distributed  to  the  different  muscles  on  the  back 
of  the  fore-arm.  Some  of  its  branches,  reach  the  wrist,  and 
anastomose  with  the  carpal  arteries. 

3.  The  ulnar  artery,  in  its  descent  on  the  fore-arm,  sends 
off  many  small  and  irregular  muscular  branches  called  by 
Professor  Chaussier,  Cubito-Musculaires ; they  do  not  re- 
quire description. 

4.  The  Dorsalis  Manus,  leaves  the  ulnar  at  the  lower 


BLOOD-VESSELS. 


345 


end  of  the  fore-arm,  and  passes  under  the  tendon  of  the 
flexor  ulnaris  to  the  back  of  the  hand.  It  there  meets  ra- 
muscles  of  the  radial  and  interosseous,  and  conjointly  they 
supply,  with  very  small  branches,  the  back  of  the  wrist,  of 
the  metcarpus,  and  of  the  fingers. 

5.  As  the  Arcus  Superficialis  is  about  beginning, 
the  ulnar  artery  sends  superficial  but  small  branches,  to  the 
integuments  of  the  palm.  And  a little  farther  on,  a consi- 
derable branch,  which  divides  into  the  bottom  of  the  palm, 
through  the  muscles  of  the  little  finger,  and  joins  the  ulnar 
extremity  of  the  arcus  profundus ; this  is  the  Cubitalis  Ma- 
nus Profunda  of  Haller. 

6.  The  Arcus  Sublimis  then  sends  a branch  to  the  ulnar 
side  of  the  little  finger.  Afterwards  in  succession,  three  di- 
gital branches  are  sent  off,  which  arriving  at  the  interstices 
between  the  heads  of  the  metacarpal  bones,  each  divides 
into  two  branches,  to  supply  the  sides  of  the  fingers  which 
are  opposite  to  each  other;  one  branch  is  called  Digito-radial, 
the  other  Digito-ulnar,  according  to  the  side  of  the  finger 
on  which  the  artery  may  be  placed. 

The  Digital  Arteries  before  they  divide,  receive  each  a 
small  branch  from  the  arcus  profundus.  The  digito-radial 
and  ulnar  arteries,  pass  along  the  front  sides  of  the  fingers 
to  their  extremities;  and  at  the  joints  and  extremities,  anas-* 
tomoses  between  the  arteries  of  the  two  sides  of  the  same 
finger,  occur. 

The  Arcus  Sublimis  terminates  on  the  radial  side  of  the 
palm  by  a branch  which  joins  the  artery  of  the  thumb,  coming 
from  the  radial. 

The  most  frequent  distribution  of  the  arteries  of  the  hand 
is  what  has  been  just  described  ; anatomists  are,  however, 
not  at  all  agreed  on  this  point.  It  would  probably  be  more 
just  to  say,  that  this  occurs  oftener  than  any  other  single  ar- 
rangement. The  variety,  in  fact,  is  so  great,  that  before  a 
hand  is  opened  it  is  not  possible  to  know  in  what  manner 
its  arteries  are  distributed.  Sometimes  the  Radial  Artery 
furnishes  one-half  of  the  arcus  sublimis,  and  the  Ulnar  the 
other  half.  On  other  occasions  the  interosseous  artery,  or 
the  superficialis  volse,  is  continued  as  a large  trunk  over 


346 


OF  THE  UPPER  EXTREMITIES. 


the  ligament  of  the  wrist,  and  across  the  root  of  the  thumb 
to  join  the  arcus  sublimis. 


OF  THE  VEINS  OF  THE  UPPER  EXTREMITIES. 

These  Veins  are  abundantly  supplied  with  valves,  and  are 
superficial  and  deep-seated  ; the  former  lying  beneath  the 
skin,  have  original  names  ; the  latter  attending  the  arteries 
on  all  occasions,  are  called  after  them.  Anastomoses  are 
numerous  in  both  sets,  but  are  particularly  so  in  the  su- 
perficial, where  plexuses  are  formed  which  surround  the 
arm. 

Three  principal  superficial  trunks  are  formed  on  the  lower 
part  of  the  fore-arm,  one  on  its  radial  side,  another  on  its 
ulnar,  and  the  third  between  tire  two. 

1.  The  Vena  Cephalica,  first  arises  about  the  root  of 
tire  thumb  and  fore-finger  on  the  back  of  the  hand;  a dis- 
tinct trunk  is  formed,  which  winds  obliquely  over  the  radius, 
and  then  runs  along  the  external  edge  of  the  fore-arm  to  the 
elbow  joint.  The  Cephalic,  ascends  afterwards  along  the 
external  margin  of  the  biceps  flexor  muscle,  lies  over  the 
interstice  between  the  pectoralis  major  and  deltoid  muscles, 
and  ascends  to  within  eight  or  ten  lines  of  the  clavicle, 
when  it  dips  into  the  axilla  to  join  the  axillary  vein.  In 
the  whole  of  this  course  it  may  be  seen  easily  beneath  the 
skin. 

2.  The  Vena  Basilica  is  larger  than  the  Cephalic,  and 
arises  by  several  branches,  from  the  back  of  the  hand,  prin- 
cipally on  the  ulnar  side,  one  of  which,  placed  between  the 
metacarpal  bone  of  the  little  finger  and  the  ring  finger,  is 
called  Vena  Salvatella.  From  this  origin,  the  basilic  vein 
gets  to  the  ulnar  side  of  the  fore-arm  and  continues  so,  to 
the  elbow  joint,  receiving  on  either  side,  anterior  and  poste- 
rior ulnar  branches;  it  is  then  on  the  inner  edge  of  the  biceps 
muscle,  and  the  pulsation  of  the  brachial  artery  may  be  felt 
beneath  it.  It  ascends  regularly  at  the  inner  edge  of  the 
biceps  and  about  the  middle  of  the  arm  becomes,  by  a 
junction  wdth  other  veins,  the  Brachial  Vein. 


BLOOD-VESSELS. 


347 


This  vein  on  the  fore-arm,  frequently  consists  in  two  trunks, 
of  which  the  posterior  is  the  largest. 

3.  The  Vena  Mediana,  arises  by  branches  from  the 
wrist,  and  from  tire  palm  of  the  hand  ; it  forms  a trunk  on 
the  front  of  the  fore-arm,  which  bifurcates  three  or  four 
inches  below  the  bend  of  the  arm.  One  branch,  the  Me- 
diana Cephalica,  joins  the  cephalic  vein ; the  second,  the 
Mediana  Basilica,  joins  the  basilic  vein. 

The  deep-seated  Veins,  called  Verne  Satellites  or  Comites, 
are  found  in  company  with  every  artery  of  the  upper  ex- 
tremity, there  being  for  the  most  part,  one  vein  to  each  side 
of  the  artery.  They  anastomose  frequently  by  branches 
which  cross  the  arteries.  At  the  elbow,  the  radial,  ulnar 
and  interosseous  satellites  unite,  and  form  a plexus  over  the 
bifurcation  of  the  brachial  artery ; from  which  plexus  a 
short  large  branch  goes  outwards  to  join  one  of  the  superfi- 
cial veins. 

The  trunk,  formed  by  the  union  of  the  satellites  of  the 
fore-arm,  passes  upwards  on  the  inner  side  of  the  brachial 
artery,  and  receives  the  small  veins  from  the  different  mus- 
cles. Sometimes  it  joins  the  basilic  about  the  middle  of  the 
arm ; on  other  occasions  it  joins  it  near,  or  in  the  axilla, 
from  which  union  results  the  axillary  vein. 

The  Vena  Axillaris,  receives  the  veins  corresponding 
with  the  circumflex,  scapular,  and  thoracic  arteries,  in  their 
proper  succession.  It  is  fixed  beneath  the  artery  and  very 
near  it,  in  the  same  sheath  of  cellular  substance.  Under 
the  clavicle  it  becomes  Vena  Subclavia;  and  as  such,  it 
passes  between  the  clavicle  and  the  first  rib,  at  the  inner  side 
of  the  subclavian  artery.  It  then  leaves  the  artery  to  go  in 
front  of  the  scalenus  anticus,  whereas  the  artery  goes  be- 
tween this  muscle  and  the  scalenus  medius.  After  crossing 
the  first  rib,  it  receives  the  superior  dorsal  vein  of  the  scapula, 
the  external  jugular,  and  afterwards  the  internal  jugular,  be- 
sides several  small  veins  from  the  skin  and  muscles  of  the 
neck.  It  terminates  at  the  internal  margin  of  the  scalenus 
anticus  in  the  Vena  Innominata. 


348 


OF  THE  UPPER  EXTREMITIES. 


SECTION  V. 


Of  the  JYerves  of  the  Upper  Extremities. 

The  Brachial  or  Axillary  Plexus,  is  formed  by  the 
junction  of  the  four  inferior  cervical  and  the  first  dorsal  nerve, 
and  supplies  the  upper  extremity  by  an  appropriation  of  nearly 
the  whole  of  their  anterior  branches,  which  are  of  consider- 
able magnitude,  especially  the  three  intermediate  ones. 
These  nerves  come  out  between  the  anterior  and  the  middle 
scalenus  muscle,  being  situated  above  and  posterior  to  the 
subclavian  artery,  at  various  heights,  according  to  the  origin 
of  each  nerve  respectively.  Almost  immediately  after  dis- 
engaging themselves  from  the  scaleni  muscles,  they  com- 
mence the  formation  of  the  plexus,  which  surrounds  the 
artery  and  continues  with  it  to  the  lower  part  of  the  axilla. 
The  fourth  and  fifth  cervical  nerves  unite  into  a common 
trunk  which  splits  into  two ; the  seventh  cervical  and  the 
first  dorsal  do  the  same ; the  sixth  cervical  also  bifurcates. 
It  is  under  the  various  combinations  of  these  different  pri- 
mary divisions,  that  the  axillary  plexus  is  formed,  from 
which  the  different  nerves  of  the  upper  extremity  proceed. 
This  plexus,  from  its  close  connexion  with  the  great  artery, 
must,  of  course,  go  between  the  subclavius  muscle  and  the 
first  rib ; and,  in  the  upper  part  of  the  axilla,  separate  the 
axillary  vein  from  the  artery  in  some  measure.  The  follow- 
ing branches  are  given  off  by  the  brachial  plexus,  besides 
the  filaments  from  its  roots  to  the  sympathetic  and  phrenic 
in  front,  already  mentioned  in  the  account  of  the  Neck. 

1.  The  Nervus  Scapularis  (or  Supra  Scapularis)  is  a 
small  branch  coming  from  the  upper  part  of  the  plexus, 
commonly  the  fourth  cervical  nerve.  It  accompanies  the 
arteria  dorsalis  scapulae  superior,  to  the  notch  in  the  upper 
costa  of  the  scapula,  and  is  distributed  to  the  muscles  on  the 
back  of  the  scapula. 

2.  The  Nervi  Subscapulares  of  Bichat,  are  about  three 
in  number ; they  come  also  from  the  central  parts  of  the 


NERVES. 


349 


plexus,  to  be  distributed  upon  the  teres  major,  latissimus 
dorsi,  and  subscapularis. 

A View  of  the  Brachial  Plexus  of  Nerves  and  its  Branches  to 
the  Arm. 

Fig.  66. 


1.1.  The  Scalenus  Anticus  Muscle. 

2.2,  The  Median  Nerve. 

3.  The  Ulnar  Nerve. 

4.  The  Branch  to  the  Biceps  Muscle. 

5.  The  Thoracic  Nerves. 

G.  The  Phrenic  Nerve,  from  the  Third  and  Fourth  Cervical. 

3.  The  Nervi  Thoracici,  are  primarily  two  or  three  in 
number.  They  arise  from  the  middle  of  the  plexus  and  are 
divided  into  anterior  and  posterior  branches,  the  former 


350 


OF  THE  UPPER  EXTREMITIES. 


being  distributed  upon  the  pectoralis  major  and  minor,  the 
latter  upon  the  serratus  major  anticus. 

4.  The  Nervus  Axillaris,  or  Circumflexus,  comes 
from  the  lower  part  of  the  brachial  plexus.  It  follows  the 
course  of  the  posterior  circumflex  artery,  winding  around 
the  upper  part  of  the  os  humeri,  between  the  teres  minor  and 
major,  in  order  to  get  to  the  internal  surface  of  the  deltoid 
muscle,  where  it  terminates.  In  its  passage  it  also  furnishes 
branches  to  the  subscapularis,  the  teres  major  and  minor, 
the  infra-spinatus,  and  to  the  integuments  on  the  back  of  the 
shoulder  and  arm. 

5.  The  Nervus  Cutaneus  Internes,  proceeds  from  the 
lower  part  of  the  brachial  plexus  between  the  median  and 
ulnar  nerves,  and  follows  the  course  of  the  basilic  vein  to 
the  elbow  or  near  it.  In  its  descent,  it  detaches  small  cuta- 
neous filaments  anteriorly  to  the  integuments  of  the  biceps, 
and  posteriorly  to  those  of  the  triceps.  A little  above  the 
bend  of  the  elbow,  commonly  where  the  median  basilic 
joins  the  basilic  vein,  or  occasionally  some  inches  higher  up, 
it  divides  into  two  terminating  branches  of  nearly  equal 
magnitude.  The  one  next  the  internal  condyle  lies  in  front 
of  the  basilic  vein,  just  at  its  junction  with  tire  median  basilic, 
and  continues  in  front  and  parallel  with  it  for  some  inches. 
It  is  distributed,  by  many  ramifications,  to  the  skin  of  the 
ulnar  side  of  the  fore-arm  and  back  of  the  hand,  some  of 
the  branches  winding  around  to  the  back  part  of  the  fore- 
arm. The  other  branch  of  the  internal  cutaneous,  passes 
beneath  the  median  basilic  vein  about  six  lines  from  its 
junction  with  the  basilic,  and  is  distributed  to  the  integu- 
ments on  the  middle  front  of  the  fore-arm.  Before  this  lat- 
ter branch  reaches  the  median  basilic  vein,  it  sends  off  a 
cutaneous  filament,  which  crosses  the  median  basilic  in  front, 
about  half-way  in  the  course  of  this  vein. 

6.  The  Nervus  Musculo-Cutaneus,  is  somewhat  larger 
than  the  preceding  and  comes  from  the  middle  of  the  bra- 
chial plexus.  It  perforates  obliquely  the  upper  part  of  the 
coraco-brachialis  muscle,  to  which  it  dispenses  filaments,  it 
then  passes  between  the  biceps  and  brachialis  internus  mus- 
cles, giving  also  filaments  to  both  of  them.  Its  course  being 


NERVES. 


351 


remarkably  oblique  under  the  biceps  muscle,  it  makes  its 
appearance  superficially,  only  a little  above  the  elbow  joint, 
near  the  external  condyle.  It  then  passes  superficially  be- 
tween the  skin  and  the  supinator  radii  longus  muscle,  dis- 
tributing filaments  in  its  course,  and  near  the  lower  part  of 
the  radius,  divides  into  two  orders  of  fibres,  one  of  which  is 
distributed  on  the  palmar  side  of  the  hand,  and  the  other  on 
the  dorsal,  but  both  go  to  the  integuments. 

7.  The  Nervtjs  Radialis,  or  Musculo-Spiralis,  arises 
from  the  upper  portion  of  the  brachial  plexus.  It  is  a large 
trunk,  which  winds  spirally  around  the  os  humeri  between 
the  triceps  muscle  and  the  bone,  entering  the  fissure  between 
the  third  and  the  first  head  of  the  triceps.  It  appears  on 
the  outside  of  the  os  humeri  between  the  brachialis  internus 
and  the  triceps  muscle,  running  for  some  inches  in  contact 
with  their  intermuscular  ligament.  While  beneath  the 
triceps  it  sends  several  branches  to  its  heads.  There  are 
three  principal  trunks  afterwards  to  this  nerve. 

a.  The  Ramus  Superficialis  Dorsalis  is  sent  from  it,  on  a 
line  with  the  point  of  the  deltoid  muscle.  This  branch, 
then,  goes  just  below  the  skin,  parallel  with  and  over  the 
external  ridge  of  the  os  humeri ; it  of  course  crosses  the 
origin  of  the  muscles  of  the  external  condyl'e.  It  continues 
superficial  on  the  posterior  external  edge  of  the  supinator 
radii  longus  muscle,  and  terminates  in  the  integuments  on 
the  back  of  the  hand. 

The  continued  trunk  of  the  muscular  spiral,  goes  in  the 
interstice  between  the  extensor  muscles  and  the  brachialis 
internus,  and  at  the  external  condyle  divides  into  the  other 
two  branches,  from  which  filaments  proceed  to  the  con- 
tiguous heads  of  the  muscles. 

b.  The  Ramus  Profundus  Dorsalis,  perforates  the  supina- 
tor brevis  muscle,  and  gets  beneath  the  radial  extensors  to 
the  back  of  the  fore-arm  ; it  is  then  distributed  in  numerous 
filaments  to  the  muscles  on  the  back  of  the  fore-arm,  some 
of  its  branches  reaching  to  the  wrist. 

c.  The  Ramus  Superficialis  Anterior,  seems  to  be  a con- 
tinuation of  the  main  trunk  of  the  nerve,  and  descending  at 


352 


OF  THE  UPPER  EXTREMITIES. 


the  anterior  margin  of  the  supinator  radii  longus  muscle,  it 
joins  with  the  radial  artery  and  continues  in  its  company  to 
a short  distance  below  the  middle  of  the  radius.  This 
position  gives  the  whole  nerve  the  name  of  radial.  Here  it 
crosses  the  bone  obliquely,  beneath  the  tendon  of  the  supi- 
nator longus,  and  then  divides  into  a palmar  and  a dorsal 
ramuscle  ; the  first  being  distributed  to  the  muscles  and  in- 
teguments of  the  thumb,  the  second  terminating,  so  as  to 
supply  the  back  of  the  hand,  of  the  thumb,  fore,  middle, 
and  ring  fingers,  to  their  extremities. 

8.  The  Nervus  Medianus,  arises  from  the  brachial  plexus, 
like  the  other  nerves.  It  descends  the  arm  at  the  inner 
edge  of  the  biceps  muscle,  along  the  anterior  surface  of  the 
humeral  artery,  adhering  firmly  to  it  and  to  the  deep-seated 
veins  by  the  cellular  substance.  As  far  as  the  elbow,  it  sends 
off  no  branch  of  importance.  There,  it  lies  at  the  side  of 
the  biceps  tendon,  crosses  the  lower  part  of  the  brachialis 
internus,  and  being  beneath  the  aponeurosis  of  the  biceps, 
it  then  perforates  the  pronator  teres,  and  gets  between  the 
flexor  sublimis  digitorum,  and  the  flexor  longus  pollicis,  and 
enters  the  palm  of  the  hand  under  the  ligamentum  carpi,  at 
the  radial  edge  of  the  tendons  of  the  flexor  sublimis.  In 
the  palm  it  is  situated  beneath  the  aponeurosis  and  the  arcus 
sublimis. 

The  Median  Nerve  dispenses  the  following  branches : At 
the  bend  of  the  arm  it  furnishes  filaments  to  the  heads  of 
the  first  layer  of  muscles  of  the  fore-arm ; and  a little  be- 
low, it  detaches  the  Nervus  Interosseous,  which  supplies  fila- 
jnents  to  the  flexor  longus  pollicis  and  flexor  profundus. 
The  interosseous  nerve  then  descends  with  the  interosseous 
artery,  in  front  of  the  interosseous  ligament,  and  terminates 
in  the  pronator  quadratus.  Before  the  median  nerve  reaches 
the  wrist,  it  sends  a branch  which  supplies  with  filaments 
the  muscles  and  integuments  of  the  ball  of  the  thumb.  In 
the  palm  of  the  hand,  it  divides  and  subdivides,  so  as  to 
furnish  the  two  sides  of  the  thumb,  of  the  fore,  of  the  middle, 
and  one  side  of  the  ring  finger  with  branches,  which  reach 
their  extremities  along  with  the  digital  arteries. 

9.  The  Nervus  Urnaris,  comes  from  the  lowest  section 


NERVES. 


353 


of  the  brachial  plexus.  It  descends  along  the  internal  an- 
terior part  of  the  triceps  muscle,  in  a groove  formed  between 
it  and  the  intermuscular  ligament,  diverging  in  this  course 
gradually  from  the  median  nerve  till  it  reaches  the  elbow, 
when  it  is  at  its  greatest  point  of  separation.  At  the 
elbow  it  is  behind  the  internal  condyle,  in  the  groove  be- 
tween it  and  the  olecranon,  and  separates  the  two  heads  of 
the  flexor  ulnaris  muscle.  It  then  gets  to  the  fore-arm,  be- 
tween this  muscle  and  the  flexor  profundus  digitorum,  and 
continues  between  them  to  within  two  inches  of  the  wrist- 
joint,  when  it  detaches  the  Ramus  Dorsalis. 

The  Ramus  Dorsalis,  slips  between  the  ulna  and  the  ten- 
don of  the  flexor  ulnaris,  runs  along  the  internal  margin  of 
the  ulna  to  the  carpus,  when  it  divides  into  ramuscles 
which  supply  the  ulnar  side  of  the  integuments  on  the 
back  of  the  hand,  and  the  backs  of  the  last  two  fingers.  At 
the  interval  between  the  heads  of  the  metacarpal  bones  of 
the  middle  and  ring  fingers,  a considerable  ramuscle,  joins 
one  from  the  ramus  superficialis  anterior  of  the  nervus  ra- 
dialis  or  musculo-spiralis. 

The  Ulnar  Nerve,  having  given  off  this  dorsal  branch, 
descends  along  the  radial  margin  of  the  tendon  of  the  flexor 
ulnaris  and  of  the  os  pisiforme,  above  the  annular  ligament, 
to  the  palm  of  the  hand.  Getting  beneath  the  aponeurosis, 
it  there  detaches  first  a deep-seated  branch,  which  penetrates 
the  muscles  of  the  little  finger  to  supply  them,  the  interossei, 
and  the  short  flexor  of  the  thumb.  The  ulnar  nerve  then 
furnishes  a superficial  branch,  and  afterwards  divides  into 
three ; one  for  the  ulnar  side  of  the  little  finger,  another  for 
the  opposing  sides  of  the  little  and  ring  finger,  and  a third 
which  joins  the  most  internal  digital  branch  of  the  median 
nerve. 

To  conclude  ; the  dissector  should  also  attend  to  what 
are  called  the  Intercosto-Humeral  N er  ves.  They  consist  of 
a branch  from  the  second,  and  another  from  the  third  tho- 
racic, which  pass  out  at  the  fore  and  lateral  parts  of  the 
thorax  ; the  first  from  beneath  the  second  rib,  and  the  other 
from  beneath  the  third  rib. 

23 


354 


OF  THE  UPPER  EXTREMITIES. 


The  first  intercost  o-humeral,  being  connected  with  a fila- 
ment from  the  internal  cutaneous,  is  distributed  upon  the 
axillary  glands,  and  the  integuments  of  the  axilla  and  inner 
side  of  the  arm.  The  second,  being  joined  by  filaments 
from  the  first,  is  chiefly  distributed  to  the  integuments  on 
the  back  of  the  arm,  some  of  its  branches  reaching  the  el- 
bow. The  numbness  of  the  inner  side  of  the  arm,  in  an- 
gina pectoris,  is  supposed  to  be  owing  to  the  sympathy  of 
these  nerves  with  the  cardiac. 


PART  III, 


CHAPTER  II. 

OF  THE  LOWER  EXTREMITIES. 


SECTION  I. 


Of  the  Fascia. 

The  Muscles  of  the  lower  Extremity,  front  the  pelvis  to 
the  foot  inclusively,  is  enveloped  by  a strong  Fascia  or 
Aponeurotic  Membrane,  lying  between  the  skin  and  the  mus- 
cles. This  fascia  consists  for  the  most  part,  of  ligamentous 
fibres,  passing  in  the  direction  of  the  length  of  the  limb,  se- 
cured together  by  transverse  filaments  of  the  same  matter, 
but  by  no  means  so  abundant.  Its  structure  undergoes 
some  variations ; its  greater  part  is  decidedly  of  the  charac- 
ter just  mentioned ; but  at  the  groin  it  is  between  the  liga- 
ment and  cellular  membrane  ; the  latter  occasionally  pre- 
dominates so  much,  that  the  appearance  of  the  first  is  lost, 
particularly  in  corpulent  subjects.  On  the  contrary,  in  the 
lean,  and  such  as  have  suffered  from  the  pressure  and  irri- 
tation of  the  part  by  hernial  protrusion,  the  ligamentous 
structure  is  well  developed.  On  the  Gluteus  Magnus  also, 
this  fascia  exists  as  a condensed  cellular  membrane,  send- 
ing in  its  processes  between  the  fasciculi  of  the  muscle. 


356 


OF  THE  UPPER  EXTREMITIES. 


The  thickness  of  the  Fascia  Femoris  is  not  uniform.  On 
the  outer  side  of  the  thigh,  knee,  and  hip,  it  is  very  thick 
and  strong;  on  the  inner  side  it  is  thin,  and  weak  compared 
with  the  other.  It  is  thick  on  the  anterior  part  of  the  leg, 
and  somewhat  thinner  on  the  posterior,  but  in  neither  is  it 
so  thick  as  at  the  outer  part  of  the  thigh.  At  the  ankle  it  is 
connected  with  the  bony  prominences  around  it,  and  in- 
creasing in  thickness,  it  constitutes  the  annular  ligament  of 
the  joint  for  confining  the  tendons  on  its  anterior  part.  It 
is  also  extended  over  the  foot,  and  is  connected  at  different 
points  to  its  margin,  so  as  to  keep  itself  tense. 

This  membrane  is  very  closely  attached  to  the  cellular 
membrane  at  every  point  of  its  external  surface,  and  is 
kept  tense  all  over,  by  its  bony  connexions.  Above,  it 
arises  from  the  exterior  margin  of  the  pelvis,  as  consti- 
tuted by  the  pubes,  Poupart’s  ligament,  the  crista  of  the 
ilium,  the  side  of  the  sacrum  and  the  ischium.  At  the 
knee,  it  is  fastened  to  the  condyles  of  the  os  femoris,  and 
to  the  head  of  the  tibia  and  fibula.  On  the  posterior  part  of 
the  thigh  it  sends  in  a long  process,  by  which  it  adheres  to 
the  linea  aspera.  Its  connexion  with  the  knee  and  ankle 
below,  fixes  it  on  the  leg;  besides  which,  it  adheres  to  the 
spine  of  the  tibia. 

Its  connexion  with  the  muscles  of  the  lower  extremity 
is  very  interesting  ; to  some  of  them  it  adheres  by  its  inter- 
nal face,  and  to  others  it  does  not.  To  the  muscles  of  the 
hip  it  adheres  closely,  and  gives  origin  to  some  of  the 
fibres  of  the  gluteus  medius.  To  the  muscles  of  the  exte- 
rior face  of  the  thigh,  its  adherence  is  generally  loose,  and 
indeed,  in  some  parts  scarcely  deserves  to  be  considered 
as  such,  as  where  the  internal  surface  of  the  fascia  is  op- 
posed to  the  tendinous  facing  of  the  vastus  externus  mus- 
cle. On  the  internal  semi-circumference  of  the  thigh,  it 
adheres  somewhat  closely  to  the  muscles,  by  cellular  mem- 
brane. On  the  leg,  it  is  in  close  connexion  with  the  mus- 
cles of  its  anterior  and  fibular  side,  many  of  their  fibres 
arising  from  it;  but  on  the  posterior  face  of  the  leg  it  is 
rather  loosely  fixed  to  them.  From  the  internal  face  of 
the  fascia,  prolongations  of  cellular  membrane  of  various 
densities,  sometimes  ligamentous,  are  sent  in  between  most 
of  the  muscles.  These  prolongations  separate  the  mus- 
cles from  each  other,  form  sheaths  in  which  they  repose. 


MUSCLES, 


357 


and  preserve  them  in  their  position.  As  an  envelope  to 
the  muscles  of  the  leg,  the  fascia  is  highly  useful  in  sup- 
porting and  sustaining  their  action.  The  knowledge  of  its 
peculiar  connexion  at  different  parts  of  the  lower  extre- 
mity, is  all  important  in  the  management  of  abscesses  of  that 
region. 

Though  useful,  it  is  not  indispensable  to  make  a complete 
investigation  of  the  fascia  at  once,  but  the  circumstances 
mentioned  should  be  very  carefully  observed,  in  extending 
downwards  the  muscular  dissection. 


SECTION  II. 

Of  the  Muscles  of  the  Lower  Extremities. 

The  Psoas  Magnus,  Psoas  Parvus  and  Iliacus  Internus 
are  described  at  page  230. 

The  Sartorius  is  placed  superficially  on  the  internal  side 
of  the  thigh,  and  arises  by  a short  tendon,  from  the  anterior 
superior  spinous  process  of  the  ilium.  A body,  of  various 
breadths  in  different  subjects  is  then  formed,  whose  fibres 
are  in  the  direction  of  its  length.  It  passes  in  a spiral 
course  to  the  inner  side  of  the  thigh  and  to  the  back  of  the 
internal  condyle,  and  winding  under  the  head  of  the  tibia, 
advances  forwards  so  as  to  be  inserted  into  the  side  of  the 
lower  -part  of  its  tubercle,  by  a broad  tendon.  The  lower 
edge  of  the  tendon  is  continued  into  the  fascia  cruralis,  by 
which  this  muscle  is  preserved  in  its  spiral  direction. 

The  sartorius  muscle  is  placed  in  its  vdiole  course  imme- 
diately beneath  the  fascia  femoris;  it  crosses  the  rectus 
femoris,  vastus  internus,  and  triceps  adductor ; at  the  lowrer 
part  of  the  thigh,  just  above  the  knee,  it  is  between  the 
tendon  of  the  latter  and  that  of  the  gracilis. 

It  bends  the  leg  and  draws  it  obliquely  inwards. 

The  Tensor  Vaginas  Femoris,  is  a short  muscle  just  on 


358 


OF  THE  LOWER  EXTREMITIES. 


the  outer  side  of  the  origin  of  the  sartorius ; it  arises,  ten- 
dinous, from  the  anterior  superior  spinous  process  of  the 
ilium,  and  passes  downwards  and  somewhat  backwards, 
between  two  laminae  of  the  fascia  femoris. 

It  is  inserted,  a little  below  the  level  of  the  trochanter 
major,  into  the  inner  face  of  the  fascia  femoris.  It  rotates 
the  foot  inwards,  and  makes  the  fascia  tense. 

The  Rectus  Femoris  is  in  front  of  the  thigh  bone,  and 
just  beneath  the  fascia  femoris,  with  the  exception  of  its 
origin  which  is  covered  by  the  sartorius.  It  is  a complete 
penniform  muscle,  fleshy  in  front  for  the  most  part,  but  faced 
behind  with  tendon.  It  arises  from  the  anterior  inferior 
spinous  process,  by  a round  tendon,  which  is  joined  by 
another  tendon  coming  from  the  superior  margin  of  the 
acetabulum. 

It  is  inserted  into  the  superior  surface  of  the  patella  by  a 
strong  tendon,  and  intermediately  by  the  ligamentum  patellae 
into  the  tubercle  of  the  tibia. 

It  extends  the  leg. 

Under  the  rectus  femoris,  the  anterior  and  lateral  parts  of 
the  thigh  bone  are  enveloped  by  a large  muscular  mass,  con- 
sidered, by  most  anatomists,  as  three  distinct  muscles,  called 
Vastus  Externus,  Vastus  Internus,  and  Cruraeusor  Cruralis. 
Their  heads  are  very  distinguishable  from  each  other ; but 
below  they  are  inseparably  united  and  join  with  the  patella. 

The  Vastus  Externus,  a very  large  muscle  on  the  out- 
side of  the  thigh,  arises,  tendinous  and  fleshy,  from  the 
upper  part  of  the  os  femoris  immediately  below  the  trochan- 
ter major.  Its  origin  commences  in  front,  and  passes  ob- 
liquely around  the  bone  to  the  linea  aspera.  It  continues 
afterwards,  to  arise  the  whole  length  of  the  linea  aspera, 
and  from  the  upper  half  of  the  line  running  from  it  to  the 
external  condyle. 

Its  fibres  pass  inwards  and  downwards,  and  are  inserted 
by  a flat  tendon,  into  the  external  edge  of  the  tendon  of  the 
rectus,  and  also  into  the  external  upper  part  of  the  patella. 
This  muscle  has  a broad  tendinous  surface  exteriorly  and 
above  ; at  its  lower  part  it  has  a tendinous  facing  on  the  side 
next  to  the  bone. 

It  also  extends  the  leg. 


MUSCLES. 


359 


The  Vastus  Internus  covers  the  whole  inside  of  the  os 
femoris.  It  arises  by  a fleshy  and  pointed  origin,  in  front 
of  the  os  femoris,  just  on  a level  with  the  trochanter  minor; 
tendinous  and  fleshy,  from  the  wrhole  length  of  the  internal 
edge  of  the  linea  aspera,  and  from  the  line  leading  from  it  to 
the  internal  condyle. 

Its  fibres  descend  obliquely,  and  are  inserted  by  a flat 
tendon  into  the  internal  edge  of  the  tendon  of  the  rectus, 
and  into  the  upper  internal  edge  of  the  patella. 

It  also  extends  the  leg. 

The  Cn.UR.a2us  Muscle,  is  almost  completely  overlapped 
and  concealed  by  the  two  vasti,  and  is  immediately  behind 
the  rectus  femoris.  The  edge  of  the  vastus  externus  above, 
is  very  distinguishable  from  it  as  it  overlaps  it,  and  is  rounded 
off,  besides  being  somewhat  separated  by  vessels.  But  the 
origin  of  the  crureeus  on  the  side  of  the  vastus  internus  is 
not  so  distinct,  as  the  fibres  of  the  two  muscles  run  together; 
it  is  therefore  necessary  most  frequently  to  cut  through  some 
of  the  fibres  on  the  internal  face  of  the  os  femoris  on  a level 
with  the  trochanter  minor.  The  crurseus  will  then  be  seen 
to  arise,  fleshy,  from  all  the  fore  part  of  the  bone,  and  from 
all  its  outside  as  far  as  the  linea  aspera.  Between  the  in- 
ternal edge  of  this  muscle  and  the  linea  aspera,  the  interior 
face  of  the  os  femoris  is  unoccupied,  for  an  inch,  along  the 
whole  shaft  of  the  bone,  which  is  very  readily  seen  by  turn- 
ing off  the  vastus  internus. 

The  Crurseus  is  inserted  into  the  posterior  face  of  the 
tendon  of  the  rectus  below,  and  into  the  upper  surface  of  the 
patella. 

It  also  extends  the  leg. 

A small  fasciculus  at  the  lower  part  of  this  muscle  which 
is  inserted  into  the  synovial  membrane  of  the  knee  joint  is 
called  by  some,  the  Sub-Crureeus. 

The  Ligamentum  Patellae  is  the  common  cord,  by  which 
the  action  of  the  last  four  named  muscles  is  communicated 
to  the  tibia.  It  is  a flattened  thick  tendon,  an  inch  and  a 
half  wide,  arising  from  the  inferior  edge  of  the  patella,  and 
inserted  into  the  tubercle  of  the  tibia.  Besides  this,  a fascia 
or  tendinous  expansion,  a continuation  of  the  fascia  of  the 
thigh  and  called  Involucrum,  comes  from  the  inferior  ends 


360 


OF  THE  LOWER  EXTREMITIES. 


of  these  muscles,  and  extends  itself  over  the  whole  of  the 
anterior  and  lateral  parts  of  the  knee  joint,  and  is  inserted 
into  the  head  of  the  tibia  and  of  the  fibula.  Through  this  it 
happens  that  even  when  the  patella  or  its  tendon  is  fractured, 
some  motion  or  extension  may  be  communicated  to  the  leg 
from  the  thigh.* 

In  consequence  of  the  common  insertion  of  these  four 
muscles,  some  anatomists  describe  them  as  but  one,  under 
the  name  of  Quadriceps  Femoris. 

A bursa  exists  between  the  lower  part  of  their  tendon  and 
the  fascia  femoris,  higher  up  than  the  patella ; occasionally 
one  is  found  still  lower  down  on  the  patella. 

The  Gracilis,  is  a beautiful  muscle  at  the  inner  margin  of 
the  thigh,  which  lies  immediately  under  the  fascia,  and  ex- 
tends from  the  pelvis  to  the  leg. 

It  arises,  by  a broad  thin  tendon,  from  the  front  of  the  os 
pubis  just  at  the  lower  part  of  its  symphysis,  and  from  its 
descending  ramus ; the  muscle  tapers  to  a point  below,  and 
a little  above  the  knee  terminates  in  a round  tendon,  which 
passes  behind  the  internal  condyle  of  the  os  femoris  and  the 
head  of  the  tibia.  It  then  makes  a curve  forwards  and 
downwards  at  the  internal  side  of  the  latter,  and  is  inserted 
at  the  lateral  and  inferior  part  of  its  tubercle. 

The  tendon  at  the  knee  is  beneath  the  tendon  of  the 
sartorius.  This  muscle  is  a flexor  of  the  leg. 

The  Pectinalis  or  Pectineus,  is  a short  fleshy  muscle  at 
the  inner  edge  of  the  psoas  magnus.  It  arises,  fleshy,  from 
the  concavity  on  the  upper  face  of  the  pubes  between  the 
linea  innominata  and  the  ridge  above  the  obturator  foramen ; 
and  is  inserted  tendinous  into  the  linea  aspera,  immediately 
below  the  trochanter  minor. 

It  draws  the  thigh  inwards  and  forwards. 

The  Triceps  Adductor  Femoris  is  a large  muscular 
mass,  consisting  of  three  distinct  portions,  which  are  placed 
at  the  inner  side  of  the  thigh,  and  contribute  much  to  fill  up 
the  vacuity  between  the  thigh  bones  above.  These  portions 
are 

* A case  of  this  kind  was  formerly  in  the  Philadelphia  Almshoi.se. 


MUSCLES. 


361 


1 . The  Adductor  Longus,  which  comes  by  a short  round- 
ed tendon,  from  the  upper  front  part  of  the  pubes  near  its 
symphysis ; it  forms  a triangular  belly  which  increases  in 
breadth  in  its  descent,  and  is  inserted  into  the  middle  third 
of  the  linea  aspera,  at  its  inner  edge. 

This  muscle,  as  the  subject  lies  on  its  back,  is  the  upper- 
most of  the  three ; its  origin  is  between  that  of  the  pectinalis 
and  of  the  gracilis ; its  upper  edge  is  in  contact  with  the 
lower  edge  of  the  pectinalis. 

2.  The  Adductor  Brevis  is  the  smallest  of  the  three ; and 
is  situated  beneath  the  adductor  longus  and  pectinalis,  and 
on  the  outside  of  the  gracilis.  It  arises  by  a rounded  tendon 
from  the  middle  front  part  of  the  pubis,  between  its  symphysis 
and  the  foramen  thyroideum,  just  below  the  origin  of  the 
first  adductor. 

It  is  inserted  into  the  upper  third  of  the  inner  edge  of 
the  linea  aspera ; between  the  trochanter  minor  and  the 
upper  edge  of  the  adductor  longus,  by  a flat  thin  tendon. 

3.  The  Adductor  Magnus  is  below  the  other  two,  and 
is  by  far  the  largest.  It  arises,  fleshy,  from  the  lower 
part  of  the  body  of  the  pubes,  and  from  its  descending  ra- 
mus, also  from  the  ascending  ramus  of  the  ischium,  as  far 
as  its  tuberosity,  occupying  the  whole  bony  surface  be- 
tween the  foramen  thyroideum  below,  and  the  margin  of 
the  bone. 

It  is  inserted,  fleshy,  into  the  whole  length  of  the  linea 
aspera,  and  on  its  internal  margin  a tendon  is  gradually 
generated,  which  passes  downwards,  to  be  inserted  into 
the  upper  part  of  the  internal  condyle  of  the  os  femoris, 
and  by  a thin  edge  or  expansion,  into  the  line  leading  from 
the  linea  aspera  to  the  internal  condyle. 

The  Adductor  Magnus  separates  the  muscles  on  the  an- 
terior from  such  as  are  on  the  posterior  part  of  the  thigh, 
and  its  insertion  is  closely  connected  with  the  origin  of  the 
vastus  internus,  the  two  surfaces  adhering  by  a short  and 
compact  cellular  membrane. 

The  three  adductors  contribute  to  the  same  end,  that  of 
drawing  the  thigh  inwards. 


362 


OF  THE  LOWER  EXTREMITIES. 


The  subject  should  now  be  turned  over,  in  order  to 
enable  us  to  study  the  muscles  on  the  back  of  the  limb. 

The  Gluteus  Magnus  arises  fleshy,  from  the  posterior 
third  or  fourth  of  the  spine  of  the  ilium,  and  the  adjoining 
flat  surface  of  the  bone,  from  the  side  of  the  sacrum  below 
it,  from  the  side  of  the  os  coccvgis,  and  from  the  poste- 
rior surface  of  the  large  sacro-sciatic  ligament.  The 
fibres  of  this  muscle  are  collected  into  large  fasciculi,  with 
deep  interstices  between  them,  and  the  lower  edge  of  it  is 
folded  over  the  posterior  sacro-sciatic  ligament. 

Its  fibres  pass  obliquely  forwards  and  downwards,  and 
terminate  in  a thick  broad  tendon,  the  upper  part  of  which 
goes  on  the  outside  of  the  trochanter  major,  and  is  very 
strongly  inserted  into  the  fascia  femoris,  while  the  lower 
part  is  inserted  into  the  upper  third  of  the  linea  aspera, 
going  down  as  far  as  the  origin  of  the  short  head  of  the 
biceps  flexor  cruris. 

This  muscle  is  placed  immediately  under  the  skin,  the 
fasciculi  being  separated  to  some  depth  by  processes  from 
the  fascia  femoris.  It  covers  nearly  all  the  other  muscles  on 
the  back  part  of  the  pelvis,  laps  over  its  inferior  margin  la- 
terally, and  conceals  the  origins  of  the  hamstring  muscles. 
There  is  a very  large  bursa  placed  between  the  tendon  of 
this  muscle,  and  the  external  face  of  the  trochanter  major; 
another  of  almost  equal  magnitude  between  it,  the  superior 
extremity  of  the  vastus  externus,  and  the  inferior  end  of  the 
tensor  vagime  femoris,  and  there  are  two  smaller  ones  be- 
tween the  same  tendon  and  the  os  femoris,  which  are  placed 
lower  and  more  posteriorly.  It  draws  the  thigh  back- 
wards and  assists  in  keeping  the  spine  erect. 

The  Gluteus  Medius  arises  from  the  whole  length  of  the 
orista  of  the  ilium,  except  its  posterior  third,  and  from  that 
part  of  the  dorsum  of  the  bone,  which  is  between  its  crista, 
and  the  semicircular  ridge,  extending  from  the  anterior  su- 
perior spinous  process,  to  the  sciatic  notch  ; also  from  the 
lunated  edge  of  the  os  ilium  between  the  anterior  superior, 
and  anterior  inferior  spinous  processes,  and  largely,  from  that 


MUSCLES. 


363 


part  of  the  inner  face  of  the  fascia  femoris  which  covers  this 
muscle. 

The  anterior  superior  part  of  this  muscle  is  not  covered 
by  the  gluteus  magnus,  but  lies  before  it.  Its  fibres  con- 
verge, and  are  inserted,  by  a broad  thick  tendon,  into  the 
upper  surface  of  the  trochanter  major,  and  into  the  upper 
anterior  part  of  the  shaft  of  the  bone,  just  in  front  of  the  same 
trochanter. 

It  draws  the  thigh  backwards  and  outwards. 

A bursa  is  interposed  between  the  extremity  of  its  tendon , 
and  the  tendinous  insertion  of  the  small  rotator  muscles. 

The  Gluteus  Minimus,  arises  from  that  part  of  the  dor- 
sum of  the  ilium,  between  the  semicircular  ridge  just  spoken 
of,  and  the  margin  of  the  capsular  ligament  of  the  hip-joint. 
It  is  entirely  concealed  by  the  gluteus  medius. 

Its  fibres  converge  and  terminate  in  a round  tendon, 
which  is  inserted  into  the  anterior  and  superior  part  of  the 
trochanter  major,  just  within  the  anterior  insertion  of  the 
gluteus  medius. 

It  adducts  the  thigh,  and  can  also  rotate  the  limb  in- 
wards. 

A bursa  of  small  size,  exists  between  its  tendon  and  the 
trochanter  major. 

There  are  several  small  muscles  about  the  hip  joint,  the 
most  of  which  can  be  seen  by  the  removal  of  the  gluteus 
magnus. 

The  Pyriformis,  arises,  fleshy  and  tendinous,  within  the 
pelvis,  from  the  anterior  face  of  the  second,  third,  and  fourth 
bones  of  the  sacrum.  It  forms  a conical  belly,  which  passes 
out  of  the  pelvis  at  the  upper  part  of  the  sacro-sciatic  fora- 
men, receiving  a slip  of  fibres  from  the  posterior  inferior 
spinous  process  of  the  ilium. 

It  is  inserted  by  a round  tendon,  into  the  upper  middle 
part  of  the  trochanter  major  within  the  insertion  of  the  glu- 
teus medius. 

It  rotates  the  limb  outwards. 

Between  its  tendon  and  the  superior  geminus,  a small 
bursa  exists. 


364 


OF  THE  LOWER  EXTREMITIES. 


A View  of  the  Deep-seated  Muscles  on  the  Posterior  Part 
of  the  Hip-Joint. 


Fig.  67. 


1.  Fifth  Lumbar  Verte- 

bra. 

2.  Ilio-LumbarLigament. 

3.  Crest  of  the  Ilium. 

4.  Anterior  Superior  Spi- 

nous Process. 

5.  Origin  of  the  Fascia 

Femoris. 

6.  Gluteus  Medius. 

7.  Its  Lower  and  Anterior 

portion. 

8.  Pyriformis. 

9.  Gemini. 

10.  Trochanter  Major. 

11.  Insertion  of  the  Glu- 

teus Med  us. 

12.  Quadratus  Femoris 

13.  Part  of  the  Adductor 

Magnus. 

14.  Insertion  of  the  Glu- 

teus Magnus. 

15.  Vastus  Exiernus. 

16.  Long  Head  of  the  Bi- 

ceps. 

17.  Semi-Membranosus. 

18.  Semi-Tendinosus. 

19.  Tuber  Ischii. 

20.  Obturator  Internus. 

21.  Point  of  the  Coccyx. 

22.  Posterior  Coccygeal 

Ligament. 

23.  I Greater  Sacro-Sciatic 

24.  ^ Ligament. 

25.  Posterior  Superior  Spi- 

nous Process  of  Ili- 
um. 

26.  Posterior  Sacro-Iliac 

Ligaments. 


The  Gemini,  are  two  small  muscles  closely  connected 
with  each  other,  which  are  situated  lower  down  on  the  limb 
than  the  pyriformis.  The  upper  one  arises  from  the  pos- 
terior part  of  the  root  of  the  spinous  process  of  the  ischium  ; 
the  lower  from  the  upper  back  part  of  the  tuberosity  of  the 
ischium. 

Being  parallel  to  each  other,  and  connected  by  their  con- 


MUSCLES. 


365 


tiguous  edges,  they  are  inserted  together  into  the  posterior 
part  of  the  thigh  bone,  at  the  root  of  the  trochanter  major, 
where  the  rough  pit  is. 

They  also  rotate  the  limb  outwards. 

The  Obturator  Internus  mucle,  is  principally  situated 
within  the  cavity  of  the  pelvis.  It  arises,  fleshy,  from  all 
the  margin  of  the  foramen  thyroideum  except  where  the  ob- 
turator vessels  go  out,  and  from  the  posterior  face  of  the 
ligamentous  membrane  stretched  across  it ; also  from  the 
upper  part  of  the  plane  of  the  ischium  just  below  the  linea 
innominata;  its  fibres  converge,  and  forming  a tendon,  pass 
out  of  the  pelvis  over  the  trochlea  of  the  ischium,  between 
the  sacro-sciatic  ligaments. 

The  tendon  is  placed  between  the  gemini  muscles,  which 
form  a sheath  for  it ; and  it  is  inserted  into  the  pit  on 
the  back  of  the  os  femoris,  at  the  root  of  the  trochanter 
major. 

Between  the  tendon  of  this  muscle  and  the  gemini,  is 
a long  bursa;  a second  is  found  where  the  muscle  plays 
over  the  ischium. 

It  rotates  the  limb  outwards. 

The  Quadratus  Femoris,  is  lower  down  than  the  other 
muscles.  It  arises,  tendinous  and  fleshy,  from  the  ridge  on 
the  outer  side  of  the  ischium,  which  constitutes  the  exterior 
boundary  of  the  tuberosity. 

Its  fibres  are  transverse ; and  are  inserted,  fleshy,  into  the 
rough  ridge  of  the  os  femoris  on  its  back  part,  which  goes 
from  one  trochanter  to  the  other. 

It  rotates  the  limb  outwards.  A bursa  exists  between 
it  and  the  trochanter  minor. 

..The  Obturator  Externus,  is  concealed  in  front  by  the 
pectineus  and  triceps  adductor,  and  behind  by  the  quadra- 
tus femoris  ; to  get  a satisfactory  view  of  it,  therefore,  these 
muscles  should  be  detached  from  the  bone.  It  arises  from 
the  whole  anterior  circumference  of  the  foramen  thyroideum, 
excepting  the  place  where  the  obturator  vessels  come  out, 
and  from  the  anterior  face  of  the  ligamentous  membrane 
stretched  across  it. 

The  fibres  of  this  muscle  conv  erge,  pass  beneath  the  cap- 


366 


OF  THE  LOWER  EXTREMITIES. 


sular  ligament  of  the  hip  joint  adhering  to  it,  and  termi- 
nate successively  in  a round  tendon,  which  is  inserted 
into  the  inferior  part  of  the  cavity  on  the  posterior  surface 
of  the  os  femoris,  at  the  root  of  the  trochanter  major.  The 
course  of  the  tendon  of  this  muscle,  is  marked  on  the  neck 
of  the  thigh  bone,  by  a superficial  fossa. 

It  rotates  the  thigh  outwards. 

The  Biceps  Flexor  Cruris,  constitutes  the  outer  ham- 
string, and  is  situated  on  the  posterior  outer  part  of  the 
thigh ; it  arises  by  two  heads.  The  first,  called  the  long 
head  has  an  origin  in  common  with  the  semitendinosus, 
from  the  upper  back  part  of  the  tuberosity  of  the  ischium 
by  a short  tendon,  which  in  its  descent,  is  changed  into  a 
thick  fleshy  belly.  The  other  called  the  short  head,  arises, 
by  an  acute  fleshy  beginning,  from  the  linea  aspera  just  be- 
low die  insertion  of  the  gluteus  magnus,  and  is  continued 
along  the  lower  part  of  the  linea  aspera,  from  the  ridge 
leading  to  die  external  condyle. 

A thick  tendon  is  gradually  formed  on  the  outside  of  the 
muscle,  which  descending  along  the  external  face  of  the 
external  condyle,  is  inserted  into  the  upper  part  of  the  head 
of  the  fibula. 

A bursa  is  found  between  this  tendon,  and  the  external 
lateral  ligament  of  the  knee. 

This  muscle  flexes  the  leg  on  the  thigh. 

The  Semitendinosus,  is  on  the  inside  of  the  thigh,  between 
the  biceps  and  gracilis;  it  is  superficial,  being  immediately 
under  the  fascia,  and  arises,  in  common  with  the  biceps, 
from  the  back  part  of  the  tuberosity  of  the  ischium ; it  also 
adheres,  for  three  or  four  inches,  to  the  inner  edge  of  the 
tendon  of  this  the  long  head  of  the  biceps. 

About  four  inches  above  the  knee  it  terminates  in  a losg 
round  tendon,  which  passes  behind  the  internal  condyle  and 
the  head  of  the  tibia,  and  is  reflected  forwards,  to  be  inserted 
into  the  side  of  the  tibia,  just  below  its  tubercle  and  very 
near  it,  being  lower  down  than  the  insertion  of  the  tendon 
of  the  gracilis.  Between  its  origin,  that  of  the  long  head  ot 
the  biceps  and  the  semimembranosus,  there  is  a bursa ; one 
or  more  are  likewise  found  between  its  tendon,  below  that 


MUSCLES. 


367 


of  the  sartorius,  of  the  gracilis  and  the  internal  ligament  of 
the  knee. 

It  flexes  the  leg  on  the  thigh. 

The  Semimembranosus  is  at  the  inner  side  of  the  thigh ; 
its  upper  part  is  concealed  by  the  semitendinosus  and  the 
origin  of  the  long  head  of  the  biceps,  and  below,  it  projects 
between  these  two  muscles.  It  is  in  contact  with  the  poste- 
rior surface  of  the  adductor  magnus. 

It  arises,  by  a thick  round  tendon,  from  the  exterior  upper 
part  of  the  tuberosity  of  the  ischium,  which  tendon  soon  be- 
comes flattened  and  sends  off  the  muscular  fibres  obliquely 
from  its  exterior  edge,  to  a corresponding  tendon  below. 
The  latter  passing  behind  the  internal  condyle  and  the  head 
of  the  tibia,  detaches  a thin  aponeurotic  membrane  under 
the  inner  head  of  the  gastrocnemius,  to  cover  the  posterior 
part  of  the  capsule  of  the  knee  joint,  and  to  be  fastened  to 
the  external  condyle. 

It  is  inserted,  by  a round  tendon,  into  the  inner  and  back 
part  of  the  head  of  the  tibia  just  below  the  joint.  The  un- 
favourable insertion  of  this  muscle  is  compensated  by  the 
course  of  its  fibres,  which  gives  it  great  increase  of  strength. 
A bursa  exists  between  its  tendon  above  and  the  quadratus; 
another  exists  between  its  tendinous  termination,  the  internal 
head  of  the  gastrocnemius  and  the  capsule  of  the  knee. 

It  flexes  the  leg  on  the  thigh. 

MUSCLES  OF  THE  LEG. 

These  muscles  are  situated  anteriorly,  posteriorly,  and 
externally. 

The  Tibialis  Anticus  muscle,  is  situated  superficially 
under  the  fascia  of  the  leg,  at  the  outside  of  the  spine  of  the 
tibia,  and  in  front  of  the  interosseous  ligament.  It  arises, 
fleshy,  from  the  head,  outer  surface,  and  spine  of  the  tibia, 
and  from  the  interosseous  ligament,  to  within  three  or  four 
inches  of  the  ankle.  It  also  arises  by  its  front  surface  from 
the  internal  face  of  the  fascia  of  the  leg. 

A rounded  long  tendon  is  formed  below,  into  which  the 
fleshy  fibres  run  obliquely  and  which,  passing  through  a dis- 


368 


OF  THE  LOWER  EXTREMITIES. 


tinct  noose  of  the  annular  ligament  in  front  of  the  malleolus 
interims,  crosses  the  astragalus  and  os  naviculare ; and  is 
inserted  on  the  inner  side  of  the  sole  of  the  foot,  into  the 
anterior  part  of  the  base  of  the  cuneiforme  internum,  and 
into  the  adjacent  part  of  the  metatarsal  bone  of  the  great 
toe. 

A bursa  surrounds  the  tendon  where  it  passes  beneath 
the  annular  ligament ; another  exists  at  its  lower  part. 

This  muscle  corresponds  with  the  radial  extensors  of  the 
arm. 

It  bends  the  foot,  and  presents  the  sole  obliquely  inwards. 

The  Extensor  Longus  Digitorum  Pedis,  is  also  super- 
ficially placed  just  under  the  fascia  of  the  leg  and  in  front  of 
the  fibula,  being  in  contact  above  with  the  tibialis  anticus, 
and  below  with  the  extensor  proprius  pollicis.  It  arises, 
tendinous  and  fleshy,  from  the  outer  part  of  the  head  of  the 
tibia,  from  the  head  of  the  fibula,  and  almost  the  whole 
length  of  its  anterior  angle ; also  from  the  upper  part  of  the 
interosseous  ligament  and  the  internal  face  of  the  fascia  of 
the  leg.  Its  fibres  go  obliquely  downwards  and  forwards 
to  the  tendon,  which  begins  not  far  from  its  upper  end  and 
descends  along  its  anterior  margin. 

About  the  middle  of  the  leg  the  tendon  splits  into  four, 
which  are  confined  by  the  annular  ligament  of  the  ankle, 
and  then  diverging,  are  inserted  respectively  into  the  base 
of  each  toe,  except  the  big  one,  and  expanded  over  its 
back  part  as  far  as  the  last  phalanx. 

Alone  bursa  is  found  enveloping  the  tendons,  where  they 
pass  beneath  the  annular  ligament  of  the  ankle. 

It  extends  all  the  joints  of  the  small  toes  and  flexes  the 
foot. 

The  Peroneus  Tertius,  is  rather  a portion  of  the  extensor 
longus;  is  found  at  its  lower  outer  part,  and  cannot  be 
naturally  separated  from  it.  It  arises  from  the  anterior 
angle  of  the  fibula,  between  its  middle  and  lower  end 

It  is  inserted,  by  a flattened  tendon,  into  the  base  of  the 
metatarsal  bone  of  the  little  toe,  and  assists  in  bending  the 
foot. 

The  Extensor  Proprius  Pollicis  Pedis,  is  between  the 


MUSCLES. 


369 


lower  part  of  the  tibialis  anticus,  and  the  extensor  longus. 
It  arises  from  the  fibula  between  its  anterior  and  internal 
angles,  by  a tendinous  and  fleshy  origin,  which  commences 
about  four  inches  below  the  head  of  the  fibula,  and  con- 
tinues almost  to  its  inferior  extremity.  A few  fibres  also 
come  from  the  interosseous  ligament,  and  from  the  lower 
part  of  the  tibia. 


Fig.  68. 


A View  of  the  Muscles  on  the  Front 
of  the  Leg. 

1.  Tendon  of  the  Quadriceps  Femoris. 

2.  Spine  of  the  Tibia. 

3.  Tibialis  Anticus. 

4.  Extensor  Communis  Digitorum. 

5.  Extensor  Proprius  Pollicis. 

6.  Peroneus  Tertius. 

7.  Peroneus  Longus. 

8.  Peroneus  Brevis. 

3.9.  Borders  of  the  Soleus. 

10.  Portion  of  the  Gastrocnemius. 

11.  Extensor  Brevis  Digitorum. 


The  muscle  being  half  penniform,  the  fibres  run  at  its 
forepart,  obliquely  to  a tendon  which  passes  through  a par- 
ticular gutter  of  the  annular  ligament,  and  over  the  astraga- 
lus, scaphoides  and  upper  internal  parts  of  the  foot,  to  be 
24 


370 


OF  THE  LOWER  EXTREMITIES. 


inserted  into  the  base  of  the  first  and  second  phalanx  of 
the  great  toe. 

A bursa  invests  this  tendon  where  it  passes  beneath  the 
annular  ligament. 

It  extends,  as  its  name  implies,  the  great  toe. 

On  the  outside  of  the  leg,  between  the  fibula  and  fascia, 
are  the  two  Peronei  muscles. 

The  Peroneus  Longus  seu  Primus,  arises  tendinous  and 
fleshy,  from  the  fore  and  outside  of  the  head  of  the  fibuia, 
from  the  space  on  its  outer  side  above,  between  the  externa! 
and  anterior  angles;  also  from  its  external  angle  to  within 
a short  distance  of  the  ankle. 

A flattened  thick  tendon  to  which  the  fibres  pass  oblique- 
ly, constitutes  the  outer  face  of  the  muscle.  This  tendon 
is  lodged  in  the  groove  at  the  posterior  part  of  the  malleolus 
externus,  being  confined  to  it  by  a thick  ligamentous  noose, 
and  furnished  there  with  a bursa.  It  then  traverses  the 
outer  side  of  the  os  calcis,  where  its  passage  is  marked 
by  a superficial  sulcus,  runs  through  the  groove  of  the  os 
cuboides  where  there  is  another  bursa,  and  lying  deep  in 
the  sole  of  the  foot  covered  by  the  calcaneo-cuboid  liga- 
ment and  next  to  the  tarsal  bones,  it  is  inserted  into  the 
base  of  the  internal  cuneiform  bone,  and  into  the  adjacent 
part  of  the  metatarsal  bone  of  the  great  toe. 

It  extends  the  foot  and  inclines  the  sole  obliquely  out- 
wards, corresponding  with  the  flexor  carpi  ulnaris  of  the 
fore-arm.  Small  sesamoid  bones  are  occasionally  found 
where  the  tendon  winds  round  the  os  cuboides. 

The  Peroneus  Brevis  seu  Secundus,  is  concealed  in  a 
great  degree  by  the  peroneus  longus,  being  situated  be- 
tween the  latter  and  the  extensor  longus  digitorum.  It 
arises,  tendinous  and  fleshy,  from  the  outer  surface  of  the 
fibula,  commencing  about  one-third  of  the  length  of  the 
bone  from  its  head,  and  continuing  almost  to  the  ankle. 

A tendinous  facing  exists  externally  also  in  this  muscle, 
to  which  its  fibres  proceed  obliquely.  This  tendon  is  con- 
tinued through  the  fossa  at  the  back  part  of  the  malleolus 
externus,  being  covered  by  the  tendon  of  the  peroneus 


MUSCLES. 


371 


]ongus,  and  confined  by  the  same  ligmentous  noose,  and 
passing  through  the  superficial  fossa  at  the  outer  side  of  the 
os  calcis,  is  inserted  into  the  external  part  of  the  base  of 
the  metatarsal  bone  of  the  little  toe.  It  extends  the  foot 
and  presents  the  sole  obliquely  downwards.  It  corresponds 
with  the  flexor  carpi  ulnaris. 

The  Triceps  Surie,  is  placed  on  the  back  of  the  leg  and 
constitutes  its  calf.  It  consists  of  the  Gastrocnemius  and 
Soleus,  which  in  fact  form  but  one  muscle. 

The  Gastrocnemius  is  the  most  superficial,  and  conceals 
the  other  in  consequence  of  its  breadth.  It  arises  from  the 
condyles  of  the  os  femoris  by  two  heads.  One  head  arises, 
tendinous,  from  the  upper  back  part  of  the  internal  condyle, 
and  fleshy,  from  the  adjacent  part  of  the  ridge  leading  to 
the  linea  aspera ; the  other  head  arises,  by  a broad  tendon 
in  the  same  way,  from  the  external  condyle  and  the  ridge 
above  it.  A triangular  vacancy  is  left  between  the  heads 
of  the  muscle,  for  the  passage  of  the  popliteal  vessels;  they 
then  join  together,  but  in  such  a way  that  the  appearance 
of  two  bellies  is  distinctly  preserved,  of  which  the  internal 
is  the  largest.  The  muscular  fibres  pass  from  a broad  ten- 
dinous facing  on  the  back  to  a corresponding  one  on  the 
front  surface  of  the  muscle,  from  the  latter  of  which  comes 
the  Tendo  Achillis. 

The  heads  of  the  gastrocnemius  being  detached  from 
their  origin,  we  then  see  the  Soleus. 

The  Soleus,  arises  fleshy,  from  the  posterior  part  of  the 
head  of  the  fibula  and  from  the  external  angle  of  that  bone 
for  two-thirds  of  its  length  down,  behind  the  peroneus 
longus.  It  also  arises,  fleshy,  from  the  oblique  ridge  on  the 
posterior  surface  of  the  tibia,  just  at  the  lower  edge  of  the 
popliteus  muscle,  and  from  the  internal  angle  of  the  tibia 
for  four  or  five  inches.  The  two  heads  are  separated  for 
the  passage  of  the  posterior  tibial  vessels. 

The  body  of  this  muscle  has  a great  intermixture  of  ten- 
dinous matter  in  it,  and  from  its  lower  extremity  proceeds 
the  other  origin  of  the  Tendo  Achillis  ; about  three  or  four 
inches  above  the  heel,  this  tendon  joins  the  anterior  face  of 
the  tendon  of  the  gastrocnemius,  and  by  the  union  of  the 


372 


OF  THE  LOWER  EXTREMITIES. 


two  is  formed  the  Tendo  Achillis,  which  is  inserted  into  the 
posterior  inferior  surface  of  the  os  calcis  near  its  tube- 
rosities. 

These  two  muscles  extend  the  foot,  and  are  all-important 
in  walking.  A bursa  is  between  these  tendons  and  the  os 
calcis. 

The  Plantaris,  is  a singular  little  muscle  concealed  by 
the  gastrocnemius,  and  has  a short  fleshy  belly,  and  a long 
tendon.  It  arises,  fleshy,  from  the  ridge  of  the  os  femoris 
just  above  the  external  condyle ; passes  across  the  capsular 
ligament  of  the  joint,  adhering  to  it  in  its  course,  and  the  belly 
terminates  somewhat  below7  the  head  of  the  tibia  in  a long 
delicate  tendon,  which  descends  between  the  inner  head  of 
the  soleus,  and  the  gastrocnemius. 

At  the  place  where  these  tendons  unite,  the  tendon  of  the 
plantaris  emerges  from  between  them,  and  running  at  the 
inner  edge  of  the  tendo  Achillis,  is  inserted  into  the  inside 
of  the  os  calcis  just  before  the  insertion  of  the  tendo 
Achillis. 

It  extends  the  foot,  but  contributes  so  little  to  its  motions, 
and  in  other  respects  is  of  such  doubtful  use,  that  its  pro- 
per destination  is  uncertain. 

The  Popliteus,  is  a triangular  muscle  on  the  back  of  the 
knee  joint.  It  arises  from  a deep  depression  on  the  exte- 
rior face  of  the  external  condyle,  by  a thick  round  tendon, 
wdiich  passes  through  the  capsular  ligament,  being  connected 
with  the  external  semilunar  cartilage,  and  then  forms  a fleshy 
belly  that  passes  obliquely  inwards  and  downwards. 

It  is  inserted,  fleshy,  into  the  oblique  ridge  on  the  back 
of  the  tibia  just  below  its  head,  and  into  the  triangular  de- 
pression above  it. 

A bursa  exists  between  its  origin,  and  the  capsular  liga- 
ment; and  its  tendon  is  in  contact  with  the  synovial  membrane 
of  the  joint. 

It  bends  the  leg,  and  when  bent,  rotates  it  inwards. 

By  removing  the  Soleus  we  expose  three  other  muscles 
on  the  back  of  the  leg,  the  Tibialis  Posticus,  the  Flexor 
Longus  Digitorum  Pedis,  and  the  Flexor  Longus  Pollicis 
Pedis.  These  muscles  are  covered  by  a thick  strong  fascia, 


MUSCLES. 


373 


from  which  some  of  their  fibres  originate,  and  which  should 
be  removed. 

Fig.  69. 


A View  of  the  Muscles  on  the  Back  of 
the  Leg. 

1.  Tendon  of  the  Biceps. 

2.  Inner  Hamstring  Tendons. 

3.  Popliteal  Space. 

4.  Gastrocnemius. 

5.  Soleus. 

G.  Tendo-Achillis. 

7.  Its  Insertion  on  the  Os  Calcis. 

8.  Tendons  of  the  Peroneus  Longus  and  Brevis. 

9.  Tendons  of  the  Tibialis  Posticus  and  Flexor 

Longus  Digitorum,  behind  the  Internal  Mal- 
leolus. 


The  Flexor  Longus  Digitorum  Pedis  Perforans,  is  be- 
hind the  tibia,  and  at  the  inner  edge  of  the  tibialis  posticus. 
It  arises,  by  an  acute,  tendinous,  and  fleshy  beginning,  from 
the  back  of  the  tibia,  a little  below  the  popliteus  muscle,  its 
origin  being  continued  from  the  internal  angle  of  the  tibia, 
almost  to  the  ankle  joint.  It  arises,  also  by  tendinous  and 
fleshy  fibres,  from  the  outer  edge  of  the  tibia,  just  above  its 
connexion  with  the  fibula  at  the  ankle,  the  latter  origin  is, 
however,  frequently  deficient ; and  between  this  double  or- 
der of  fibres,  the  tibialis  posticus  lies. 


374 


OF  THE  LOWER  EXTREMITIES. 


The  fibres  pass  obliquely  into  a tendon  at  the  posterior 
edge  of  the  muscle,  which  runs  in  the  groove  behind  the  in- 
ternal malleolus,  and  is  confined  there  by  a strong  ligamen- 
tous sheath,  being  placed  behind,  and  within  the  tendon  of 
the  tibialis  posticus.  The  tendon  then  gets  to  the  sole  of 
the  foot  along  the  sinuosity  of  the  os  calcis,  and  being 
joined  by  a considerable  tendon,  detached  from  the  flexor 
longus  pollicis,  it  divides  into  four  branches  which  are  ap- 
propriated to  the  four  small  toes. 

These  tendons  are  inserted  into  the  bases  of  the  third 
phalanges  of  the  lesser  toes,  are  very  near  the  tarsal  bones, 
and  from  perforating  the  tendons  of  the  flexor  brevis,  cor- 
respond with  the  flexor  perforans  of  the  hand. 

A bursa  exists,  where  the  tendon  passes  along  the  tibia 
and  the  os  calcis ; and  another  is  found  in  the  sole  of  the 
foot,  enveloping  this  tendon  and  that  of  the  flexor  longus 
pollicis.  A fifth  tendon,  is  sometimes  observed,  which 
splits  and  goes  to  the  second  bone  of  the  small  toe ; this 
occurs  when  the  latter  is  not  Supplied  from  the  flexor 
brevis. 

This  muscle  flexes  the  small  toes  and  extends  the  foot. 

The  Flexor  Longus  Pollicis  Pedis,  is  a stout  muscle 
formed  of  oblique  fibres,  situated  on  the  back  part  of  the 
fibula,  and  at  the  outer  side  of  the  tibialis  posticus.  It  arises 
by  an  acute,  tendinous,  and  fleshy  beginning,  from  the 
posterior  flat  surface  of  the  fibula,  commencing  about 
three  inches  from  its  head,  and  continuing  almost  to  the 
ankle. 

The  tendon  of  this  muscle  is  large  and  round,  forms 
gradually,  and  constitutes  a facing  to  the  posterior  edge  of 
the  muscle.  It  passes  through  a superficial  fossa  of  the  tibia 
at  the  back  of  the  ankle,  near  its  middle,  and  from  thence 
through  a notch  in  the  back  edge  of  the  astragalus  to  the 
sole  of  the  foot,  where  it  crosses  the  tendon  of  the  flexor 
longus  digitorum,  and  gives  off  the  branch  just  mentioned  to 
join  it,  which  goes  principally  to  the  second  toe.  This 
tendon  is  deeper  seated  in  the  foot  than  the  other. 

The  tendon  of  the  flexor  longus  pollicis  is  inserted  into 


MUSCLES. 


375 


the  second  phalanx  of  the  great  toe.  It  bends  the  great  toe, 
and  from  its  connexion  with  the  others,  will  bend  them 
also. 

A bursa  invests  its  tendon  in  the  canal  of  the  astragalus, 
and  along  the  os  calcis ; another,  as  stated,  is  common  to  it 
and  the  flexor  perforans  muscle,  and  a third  invests  the  ten- 
don along  the  metatarsal  bone,  and  the  first  phalanx  of  the 
great  toe. 

The  Tibialis  Posticus  is  placed  between,  and  concealed 
by  the  last  two  muscles.  It  arises,  by  a narrow  fleshy  be- 
ginning, from  the  front  of  the  tibia,  at  the  under  surface  of 
the  process  wThich  joins  it  to  the  fibula,  and  then  gets  to  the 
back  of  the  leg,  through  a hole  in  the  interosseous  ligament. 
It  continues  its  origin  from  the  whole  of  the  interosseous  li- 
gament, and  from  the  surfaces  of  the  tibia  and  fibula,  bor- 
dering on  the  ligament,  excepting  one-third  of  the  lowrer 
part  of  the  fibula,  and  rather  more  of  the  lower  part  of  the 
tibia. 

The  fleshy  fibres  run  obliquely  to  a middle  tendon,  which 
passes  in  the  groove  at  the  back  of  the  malleolus  internus, 
and  is  confined  there  by  a fibro-cartilaginous  noose,  and  in- 
vested by  a bursa.  It  is  inserted  into  the  upper  internal 
part  of  the  os  naviculare,  or  scaphoides,  at  its  tuberosity, 
and  also  divides  in  such  a way,  as  to  be  inserted  into  the 
internal  and  external  cuneiform  bones,  into  the  os  cuboides, 
and  os  calcis. 

It  extends  the  foot,  and  presents  the  sole  obliquely  in- 
wards, corresponding  with  the  flexor  radialis  of  the  hand. 


OF  THE  MUSCLES  OF  THE  FOOT. 

The  Extensor  Brevis  Digitorum  Pedis,  is  the  only 
muscle  on  the  superior  surface  of  the  foot.  It  is  placed  be- 
neath the  tendons  of  the  extensor  longus,  and  arises,  tendi- 
nous and  fleshy,  from  the  upper  fore  part  of  the  greater  apo- 
physis of  the  os  calcis,  being  connected  with  the  origin  of  the 
annular  ligament  of  the  ankle.  It  forms  a short  fleshy  belly, 


376 


OF  THE  LOWER  EXTREMITIES. 


which  is  partially  divided  into  four  parts ; from  these  bel- 
lies proceed  as  many  tendons,  which  crossing  very  obliquely 
the  tendons  of  the  extensor  longus,  are  inserted  into  the 
great  toe  and  the  three  next  toes,  by  joining  with  the  ten- 
dons of  the  extensor  longus,  which  are  spread  over  their 
backs. 

The  tendon  going  to  the  great  toe,  has  its  principal  inser- 
tion into  the  first  phalanx.  It  extends  the  toes. 

The  Sole  of  the  Foot  is  protected,  in  the  first  place,  by 
an  unusual  thickness  of  its  cuticle,  which  is  increased  in 
such  parts  as  are  most  pressed  upon,  as  the  heel,  and  the 
ball  of  the  great  toe. 

Beneath  it,  is  a thick  layer  of  adipose  matter,  found  in  the 
most  emaciated  as  well  as  the  most  corpulent  subjects, 
which  seems  to  be  less  under  the  influence  of  the  causes 
producing  a diminution  or  increase  of  fat,  than  the  adipose 
matter  in  any  other  part  of  the  body.  It  is  collected  into 
granulations,  separated  from  each  other  by  processes  of  con- 
densed cellular  membrane  resembling  ligament,  that  pass 
from  the  interior  surface  of  the  skin  to  the  aponeurosis  plan- 
taris.  It  fills  up  completely  all  the  fissures  in  this  aponeu- 
rosis, and  adheres  very  closely  to  it,  so  that  it  requires 
much  trouble  to  get  out  a fair  dissection  of  the  aponeu- 
rosis. 

The  Aponeurosis,  or  Fascia  Plaxtaris,  is  a ligamen- 
tous membrane  extending  from  the  tuberosities  of  the  os 
calcis,  to  the  anterior  ends  of  the  metatarsal  bones.  It  is 
triangular,  and  corresponds  with  the  outline  of  the  foot,  by 
being  narrow7  behind,  and  broad  before.  It  is  divided  into 
three  parts,  according  to  the  division  of  the  muscles  of  the 
foot,  one  part  lying  on  the  muscles  at  the  outside  of  the 
sole,  another  on  the  muscles  at  the  inside  of  the  sole,  and 
the  third  being  between  the  other  two.  The  internal  and 
external  portions  are  thin  and  reticulated;  they  extend  from 
the  tuberosities  of  the  os  calcis  to  the  roots  of  the  internal 
and  external  metatarsal  bones,  and  are  scarcely  seen  be- 
yond them.  But  the  central  portion  is  remarkably  strong 
near  the  heel,  and  dimishes  in  thickness  as  it  spreads  out. 
Anteriorly,  it  is  divided  into  five  portions,  one  for  each 


MUSCLES. 


377 


metatarsal  bone;  each  of  these  portions  is  bifurcated,  and 
dips  down  to  be  inserted  on  either  side  of  the  metatarsal 
bone  near  its  head  and  into  the  bases  of  the  first  phalanges 
of  the  toes.  Between  the  prongs  of  each  bifurcation  pass 
the  tendons,  nerves,  &c.,  to  the  toes.  The  interior  face  of 
this  membrane  affords  origin  to  many  of  the  muscular  fibres, 
and  from  it  proceed  vertical  partitions,  separating  the  mus- 
cles of  the  middle  of  the  foot  from  such  as  are  on  each  side 
of  it. 

When  the  Aponeurosis  Plantaris  is  removed,  we  see 
three  muscles;  the  middle  one  under  the  large  central 
portion  of  the  aponeurosis,  is  the  Flexor  Brevis  Digitorum 
Pedis,  the  outer  is  the  Abductor  Minimi  IDigiti,  and  the 
inner  the  Abductor  Pollicis  Pedis. 

The  Flexor  Brevis  Digitorum  Pedis,  arises  fleshy, 
from  the  large  tuberosity  of  the  os  calcis  by  a narrow  be- 
ginning, also  from  the  interior  surface  of  the  aponeurosis 
and  the  tendinous  septa  between  it  and  the  contiguous 
muscles.  t 

It  forms  a fleshy  belly,  going  nearly  as  far  forwards  as  the 
middle  of  the  metatarsal  bones;  there  it  divides  into  four 
tendons,  which  go  to  the  smaller  toes.  These  are  per- 
forated by  the  tendons  of  the  flexor  longus,  and  are  inserted 
into  the  sides  of  the  second  phalanges.  The  tendon  for 
the  little  toe  is  often  deficient. 

It  bends  the  second  joint  of  the  toes. 

By  detaching  this  muscle  from  its  origin  and  turning  it 
down,  we  bring  into  view  the  tendon  of  the  Flexor  Longus 
Digitorum  Pedis,  and  its  attachments  behind,  to  the  ten- 
dinous slip  from  the  Flexor  Longus  Pollicis,  and  to  the 
Massa  Carnea  Jacobi  Sylvii,  or  Flexor  Accessorius,  and 
before,  to  the  Lumbricales  muscles. 

The  Flexor  Accessorius,  is  at  the  outside  of  the  tendon 
of  the  flexor  longus  digitorum  pejis.  It  arises,  fleshy,  from 
the  inside  of  the  sinuosity  of  the  os  calcis,  and  by  a thin 
tendon,  from  the  outside  of  the  bone  before  its  posterior 
tuberosities. 

It  is  inserted,  fleshy,  into  the  outside  of  the  tendon  of  the 


378 


OF  THE  LOWER  EXTREMITIES. 


flexor  longus,  just  at  its  division  into  four  tendons.  Like 
a second  hand  at  a rope,  it  assists  in  flexing  the  toes. 

Fig.  70. 


A View  of  the  Muscles  of  the  Sole  of 
the  Foot  immediately  under  the  Plan- 
tar Fascia. 

1.  Os  Calcis. 

2.  Section  of  the  Fascia  Plantaris. 

3.  Abductor  Pollicis. 

4.  Abductor  Minimi  Digiti. 

5.  Flexor  Brevis  Digitorum. 

6.  Tendon  of  the  Flexor  Longus  Pollicis. 

7.7.  Lumbricales. 


The  Lumbricales  Pedis,  are  four  small  tapering  muscles 
which  arise  from  the  tendon  of  the  flexor  longus  digitorum 
pedis,  just  after  its  division,  or  while  it  is  in  the  act  of 
dividing.  One  of  them  is  appropriated  to  each  lesser  toe, 
and  is  inserted  into  the  inside  of  its  first  phalanx,  and  into 
the  tendinous  expansion  that  is  sent  off  from  the  extensor 
muscle  to  cover  its  back. 

They  increase  the  flexion  of  the  toes  and  draw  them 
inwards. 

The  Abductor  Pollicis  Pedis,  arises  tendinous  and  fleshy, 
from  the  internal  anterior  part  of  the  large  tuberosity  of  the 
os  calcis,  from  a ligament  extended  from  this  tuberosity  to 
the  sheath  of  the  tendon  of  the  tibialis  posticus,  from  the  in- 
ternal side  of  the  naviculare,  and  from  the  cuneiforme  in- 
ternum, being  apart  of  the  aponeurosis  of  the  sole  of  the  foot. 

It  forms  the  internal  margin  of  the  sole  of  the  foot,  and 


MUSCLES. 


379 


is  inserted,  tendinous,  into  the  internal  sesamoid  bone  and 
into  the  base  of  the  first  phalanx  of  the  great  toe. 

It  draws  the  great  toe  from  the  rest. 

The  Flexor  Brevis  Pollicis  Pedis,  is  situated  imme- 
diately at  the  exterior  edge  of  the  abductor  pollicis.  It 
consists  of  two  bellies,  parallel  with  each  other,  but  sepa- 
rated by  the  tendon  of  the  flexor  longus  pollicis;  one  is 
inseparably  connected  with  the  tendon  of  the  abductor  pol- 
licis, and  the  other  with  the  adductor  pollicis. 

It  arises,  tendinous,  in  common  with  the  calcaneo-cuboid 
ligament,  from  the  under  part  of  the  os  calcis  just  behind  its 
connexion  with  the  os  cuboides,  and  from  the  under  part 
of  the  external  cuneiform  bone. 

The  internal  belly  is  inserted,  tendinous,  into  the  internal 
sesamoid  bone  along  with  the  tendon  of  the  abductor  polli- 
cis; and  the  external  belly  is  inserted,  tendinous,  into  the 
external  sesamoid  bone  along  with  the  tendon  of  the  ad- 
ductor pollicis.  Each  insertion  is  continued  on  to  the  base 
of  the  first  phalanx  of  the  great  toe. 

It  flexes  the  great  toe. 

The  Adductor  Pollicis  Pedis,  is  situated  at  the  outside 
of  the  flexor  brevis,  and  is  extended  obliquely  across  the 
metatarsal  bones.  It  arises,  tendinous  at  the  external  part 
of  the  foot,  from  the  calcaneo-cuboid  ligament,  and  from  the 
roots  of  the  second,  third,  and  fourth  metatarsal  bones. 

It  is  inserted,  tendinous,  into  the  external  sesamoid  bone, 
which  insertion  is  continued  to  the  first  phalanx  of  the  great 
toe,  and  is  closely  united  to  the  tendon  of  the  external  head 
of  the  flexor  brevis  pollicis. 

It  draws  the  great  toe  towards  the  others. 

The  Abductor  Minimi  Digiti  Pedis,  forms  the  external 
margin  of  the  sole  of  the  foot,  and  is  immediately  beneath 
the  aponeurosis  plantaris.  It  arises,  tendinous  and  fleshy, 
from  the  outer  tuberosity  of  the  os  calcis,  and  also  from  the 
exterior  part  of  the  base  of  the  metatarsal  bone  of  the  little 
toe. 

It  is  inserted,  by  a round  tendon,  into  the  exterior  part 
of  the  base  of  the  first  phalanx  of  the  little  toe. 

It  draws  the  little  toe  from  the  other  toes. 


380 


OF  THE  LOWER  EXTREMITIES. 


The  Flexor  Brevis  Minimi  Digiti  Pedis  is  just  within 
the  tendon  of  the  abductor  minimi  digiti.  It  arises  from 
the  calcaneo  cuboid  ligament,  as  extended  from  the  tube- 
rosity of  the  cuboid  bone  to  the  heads  of  the  metatarsal 
bones;  also  from  the  base  of  the  outer  or  fifth  metatarsal 
bone. 

It  is  inserted,  by  a tendon,  into  the  lower  part  of  the 
first  phalanx  of  the  little  toe  at  its  base,  and  into  the  head 
of  the  metatarsal  bone  of  the  same  toe.  It  bends  the  little 
toe. 

The  Transversalis  Pedis,  is  placed  beneath  the  tendons 
of  the  flexor  muscles,  the  sole  of  the  foot  being  upwards. 
It  is  small,  and  lies  across  the  anterior  extremities  of  the 
metatarsal  bones.  It  arises,  tendinous,  from  the  capsular 
ligament  of  the  first  joint  of  the  little  toe ; it  also  arises  from 
the  capsule  of  the  first  joint  of  the  next  toe. 

It  is  inserted  into  the  exterior  face  of  the  common  tendon 
of  the  adductor  and  flexor  brevis  pollicis,  at  the  external 
sesamoid  bone. 

It  approximates  the  heads  of  the  metatarsal  bones. 

The  Interosseous  Muscles  are  seven  in  number,  four  of 
which  may  be  seen  on  the  upper  surface  of  the  foot. 
There  are  two  to  the  first  small  toe,  two  to  the  second,  two 
to  the  third,  and  one  to  the  fourth  or  little  toe.  The  mus- 
cles seen  on  the  upper  side  of  the  foot,  are  for  the  most  part 
double  headed,  that  is,  they  arise  from  the  contiguous  sur- 
faces of  the  metatarsal  bones. 

The  Interosseous  Primus  Digiti  Primi  Pedis,  or  the 
Abductor  Indicis  Pedis,  is  seen  superiorly.  It  is  placed 
between  the  metatarsal  bone  of  the  great  toe  and  the  first 
small  toe,  and  arises,  fleshy,  by  a double  head,  from  the 
opposed  surfaces  of  their  roots  and  bodies. 

It  is  inserted,  tendinous,  into  the  inside  of  the  root  of  the 
first  joint  of  the  first  small  toe,  and  pulls  it  inwards. 

The  Interosseous  Secundus  Digiti  Primi,  or  the  Ad- 
ductor Indicis  Pedis,  is  also  external  or  above.  It  is 
situated  between  the  metatarsal  bones  of  the  first  and 


MUSCLES. 


381 


second  small  toes,  arising  from  the  opposed  surfaces  of  their 
roots  and  bodies  by  a double  fleshy  and  tendinous  head. 

It  is  inserted  into  the  outside  of  the  first  phalanx  of  the 
same  toe  by  a tendon.  It  draws  this  toe  outwards. 

The  Interosseous  Secundus  Digiti  Secundi,  or  the  Ad- 
ductor Medii  Digiti,  is  seen  at  the  upper  part  of  the  foot, 
between  the  second  and  third  metatarsal  bones  of  the  lesser 
toes,  arising  from  the  opposed  surfaces  of  their  roots  and 
bodies. 

It  is  inserted,  tendinous,  into  the  outside  of  the  base  of 
the  first  phalanx  of  the  second  small  toe.  It  draws  this  toe 
outwards. 

The  Interosseous  Secundus  Digiti  Tertii,  or  the  Ad- 
ductor Tertii  Digiti,  is  seen  on  the  upper  surface  of  the 
foot,  occupying  the  interval  of  the  metatarsal  bones  of  the 
third  and  fourth  small  toes,  and  arises,  by  a double  head, 
from  the  opposite  surfaces  of  their  roots  and  bodies. 

It  is  inserted,  tendinous,  into  the  outside  of  the  root  of 
the  first  phalanx  of  the  third  small  toe. 

It  draws  this  toe  outwards. 

The  Interosseous  Primus  Digiti  Secundi  Pedis,  or  the 
Abductor  Medii  Digiti,  is  at  the  bottom  of  the  foot,  and 
arises  from  the  Inside  of  the  metatarsal  bone  of  the  second 
small  toe. 

It  is  inserted  into  the  inside  of  the  first  phalanx  of  the 
second  toe. 

It  draws  this  toe  inwards. 

The  Interosseous  Primus  Digiti  Tertii,  or  the  Adduc- 
tor Tertii  Digiti,  is  in  the  sole  of  the  foot.  It  arises  from 
the  inside  of  the  metatarsal  bone  of  the  third  toe  near  its 
root,  and  is 

Inserted,  tendinous,  into  the  inside  of  the  base  of  the  first 
phalanx  of  the  same  toe. 

It  draws  this  toe  inwards. 

The  Interosseus  seu  Adductor,  Digiti  Minimi,  is  on 
the  under  surface  of  the  foot.  It  arises  from  the  inside  of 


382 


OF  THE  LOWER  EXTREMITIES. 


the  base  of  the  metatarsal  bone  of  the  fourth  small,  or  the 
little  toe,  and  is 

Inserted,  tendinous,  into  the  inside  of  the  first  phalanx  of 
the  little  toe.  It  draws  this  toe  inwards. 


SECTION  III. 


Of  the  Blood-  Vessels  of  the  Lower  Extremities. 

The  Femoral  Artery,  (Arteria  Femoralis,)  is  a conti- 
nuation of  the  external  iliac.  It  appears  first  on  the  thigh, 
half-way,  or  nearly  so,  between  the  symphysis  pubis  and 
the  anterior  superior  spinous  process  of  the  ilium ; emerging 
from  beneath  Poupart’s  ligament,  it  is  there  covered  only 
by  the  skin  and  fascia  of  the  part,  having  the  femoral  vein 
at  its  inside,  and  the  trunk  of  the  anterior  crural  nerve, 
about  half  an  inch  from  it,  on  the  outside.  It  lies  upon  the 
psoas  magnus  muscle,  crosses  the  pectinalis,  and  the  whole 
of  the  insertion  of  the  adductor  longus  muscle.  About  one- 
third  of  the  length  of  the  thigh  bone  from  below,  it  pene- 
trates the  insertion  of  the  adductor  magnus  and  gets  to  the 
ham,  being  then  behind  the  leg.  For  the  upper  third  of 
its  course  the  femoral  artery  is  at  the  inner  edge  of  the  rec- 
tus femoris,  and  but  a little  distance  from  it;  it  then  inclines 
inwards  and  occupies  the  angle  formed  by  the  contact  ot 
the  vastus  internus,  and  the  adductor  longus.  Above,  the 
sartorious  is  at  its  outside  ; but  as  this  muscle  inclines  very 
rapidly  inwards,  immediately  after  its  origin,  it  in  a little 
time  begins  to  pass  along  the  external  margin  of  the  ar- 
tery; and  shortly  afterwards  covers  the  artery  completely 
to  the  place  where  it  penetrates  the  adductor.  Where  the 
artery  lies  in  the  angle  formed  by  the  adductor  longus, 
and  the  vastus  internus,  it  is  covered  by  a strong  inter- 
lacing of  tendinous  fibres  from  the  muscles,  and  is  also  en- 
veloped by  its  own  cellular  coal. 

To  cut  upon  the  femoral  artery  in  any  part  of  its  course, 


BLOOD-VESSELS. 


38,* 


lay  the  subject  horizontally,  and  turn  the  leg  outwards,  so 
that  the  external  margin  of  the  sole  of  the  foot  will  be  in 
contact,  or  nearly  so,  with  the  table.  A line  drawn  then, 
from  midway  between  the  anterior  superior  spine  of  the 
ilium,  and  the  symphysis  pubis,  to  the  centre  of  the  inter- 
nal condyle  of  the  os  femoris,  will  be  precisely  over  it.* 

The  following  branches  come  from  the  Femoral  Artery : 

1.  The  Superficial  Artery  of  the  Abdomen,  called  by' 
Haller,  Arteria  ad  Cutem  Abdominis,  is  small  and  arises 
at  the  lower  margin  of  Poupart’s  ligament.  It  goes  up- 
wards towards  the  umbilicus,  under  the  skin,  and  sends  a 
branch  to  supply  the  inguinal  glands. 

2.  The  External  Pudic  Arteries,  (Arterise  Pudendse 
Externae,)  come  from  the  Femoral  at  the  same  point,  and 
are  two  or  three  in  number;  they  are  sent  to  the  integu- 
ments and  lymphatic  glands  of  the  groin,  also  to  the  skin 
of  the  penis  and  scrotum  of  the  male,  or  to  the  labia  ex- 
terna of  the  female.  One  of  these  trunks  arises  from  the 
upper  internal  part  of  the  femoral  artery,  and  the  other 
sometimes  from  the  profunda. 

The  arteries  as  yet  mentioned,  anastomose  freely  with 
each  other;  are  irregular  in  their  number,  size,  and  origin, 
but  for  the  most  part  do  not  exceed  the  size  of  a common 
knitting-needle. 

3.  The  Profound  Artery,  (Arteria  Profunda  Femoris,) 
is  very  happily  called,  bv  Professor  Chaussier,  the  great 
muscular  artery  of  the  thigh,  in  consequence  of  its  distri- 
bution. It  is  slightly  inferior  in  size  to  the  femoral  itself, 
and  arises  from  its  posterior  part  on  a level  with  the  tro- 
chanter minor,  but  sometimes  only  five  or  six  lines  below 
Poupart’s  Ligament.  It  immediately  begins  to  give  off 
branches  externally  and  internally,  but  the  main  trunk  of 
the  artery,  continues  for  several  inches  in  contact  with  the 
femoral  artery  or  nearly  so,  and  beneath  it.  It  then  ter- 
minates gradually  by  branches  which  penetrate  to  the  back 
of  the  thigh. 

The  Profunda  Femoris  is  distributed  as  follows  : 


* Marjolin. 


384 


OF  THE  LOWER  EXTREMITIES. 


a.  The  External  Circumflex,  (Arteria  Circumflexa 
Externa,)  arises  from  its  external  superior  part,  sometimes, 
however,  from  the  femoral  itself;  it  passes  outwards  under 
the  sartorius  and  the  rectus  femoris,  and  divides  into  two 
secondary  branches.  The  superior  and  shorter  of  these 
is  distributed  to  the  parts  about  the  trochanter  major,  as 
the  anterior  edges  of  the  gluteus  medius  and  minimus,  the 
capsule  of  the  hip  joint,  and  the  heads  of  the  extensor 
muscles.  The  second  goes  along  the  outside  of  the  thigh 
lo  the  patella,  and  is  about  the  size  of  a crow-quill.  It 
first  passes  obliquely  between  the  rectus  and  the  cruraeus, 
and  then  vertically,  under  the  anterior  margin  of  the  vas- 
tus externus,  between  it  and  the  crurseus,  till  it  terminates 
about  the  knee,  by  anastomosing  with  the  articular  arte- 
ries. It  is  principally  distributed  to  the  cruraeus  and  vas- 
tus externus. 

b.  The  Internal  Circumflex,  (Art.  Circumflexa  In- 
terna) arises  from  the  inner  side  of  the  profunda,  just  be- 
low the  external  circumflex,  but  sometimes  it  also  comes 
from  the  femoral.  It  is  somewhat  under  the  size  of  the 
other,  and  penetrates  between  the  psoas  magnus  and  pec- 
tineus;  it  winds  under  the  neck  of  the  os  femoris,  and  di- 
vides into  two  branches  which  supply  the  contiguous  parts, 
as  the  heads  of  the  muscles  and  the  joint. 

c.  Several  ramifications  are  also  sent  from  the  profunda 
to  supply  the  anterior  faces  of  the  adductor  muscles; 
they  are  irregular  in  number,  size,  and  place  of  origin, 
and  have  no  appropriate  names. 

d.  The  Perforating  Arteries,  (Rami  Profundi  Perfo- 
rantes,)  three  or  four  in  number,  are  given  off  successively, 
are  numerically  named,  and  all  penetrate  the  adductor  mus- 
cles near  the  thigh  bone,  to  get  to  the  back  of  the  thigh. 

The  First,  arises  immediately  below  the  little  trochanter, 
and  gets  through  the  adductor  magnus  just  below  the  quad- 
ratus  femoris,  to  be  distributed  about  the  heads  of  the  ham- 
string muscles. 

The  Second  penetrates  the  adductor  magnus,  at  the  lower 


BLOOD-VESSELS. 


385 


part  of  the  insertion  of  the  gluteus  maximus  into  the  linea 
aspera,  to  be  distributed  about  there,  and  to  the  correspond- 
ing section  of  the  long  head  of  the  biceps  flexor  cruris. 

The  Third,  penetrates  the  adductor  magnus  a little  below 
the  commencement  of  the  origin  of  the  short  head  of  the  bi- 
ceps, and  is  distributed  thereabout. 

The  Fourth,  penetrates  the  adductor  magnus  about  an 
inch  and  a half  above  the  hole  for  the  femoral  artery, 
and  is  distributed  to  the  neighbouring  part  of  the  adductor 
and  to  the  hamstring  muscles. 

After  the  origin  of  the  profunda,  the  femoral  artery  gives  off 
three  or  four  twigs  the  size  of  a large  knitting-needle,  which 
are  disposed  of,  upon  the  sartorious,  adductors,  vastus  in- 
ternus,  and  integuments,  but  they  are  too  irregular  in  num- 
ber, origin,  and  course,  for  systematic  description. 

The  Anastomosing  Artery,  (Arteria  Anastomotica,)  the 
last  branch  of  the  femoral,  is  sent  from  it  just  before  it  en- 
ters the  aperture  in  the  adductor  magnus.  This  artery  de- 
scends, in  the  course  of  the  tendon  of  this  adductor,  to  the 
knee,  in  front  of  the  tendon,  between  it  and  the  vastus  in- 
ternus  muscle.  It  is  distributed  to  the  parts  lying  along  its 
course. 

The  Pofliteal  Artery,  (Arteria  Poplitaea)  is  the  con- 
tinuation of  the  femoral  after  the  latter  has  passed  through 
the  adductor  tendon,  and  got  to  the  back  of  the  lower  ex- 
tremity, and  extends  from  this  point,  to  the  opening  in  the 
interosseous  ligament  of  the  leg,  just  below  the  heads  of  the 
bones.  Its  first  act  is  to  cross  obliquely  the  os  femoris  as  far 
its  middle ; it  then  passes  in  a vertical  line  downwards,  very 
nearly  over  the  centre  of  the  os  femoris,  knee  joint,  and 
head  of  the  tibia,  being  only  separated  from  these  parts  in 
consequence  of  a thick  envelope  of  fat,  which  fills  up  the 
hollow  of  the  ham,  and  protects  the  artery  from  the  effects 
of  sudden  flexions  of  the  part,  and  of  bruises.  The  Popli- 
teal Artery  sends  off  the  following  branches. 

1.  The  Superior  Internal  Articular  Artery,  (Articu- 

25 


386 


OF  THE  LOWER  EXTREMITIES. 


laris  Superior  Interna)  sometimes  exists  as  two  trunks ; it 
arises  just  above  the  internal  condyle,  perforates  the  ad- 
ductor tendon,  and,  going  horizontally,  is  spent  on  the  inner 
side  of  the  joint  above. 

2.  The  Superior  External  Articular  Artery,  (Articu- 
laris  Superior  Externa)  arises  just  above  the  external  con- 
dyle, passes  horizontally  between  the  femur  and  the  biceps 
flexor,  and  is  distributed  to  the  upper  external  parts  of  the 
joint. 

3.  The  Middle  Articular,  (Articularis  Media)  some- 
times comes  from  one  of  the  others;  it  is  distributed  to  the 
posterior  middle  parts  of  the  knee  joint. 

4.  The  Inferior  Internal  Articular  Artery,  (Articu- 
laris Inferior  Interna)  arises  on  a level  with  the  inferior  part 
of  the  internal  condyle.  It  descends  obliquely,  passes 
between  the  lateral  ligament  and  the  head  of  the  tibia,  and 
then  mounts  towards  the  patella,  to  be  distributed  in 
numerous  branches. 

5.  The  Inferior  External  Articular  Artery,  (Articu- 
laris Inferior  Externa,)  arises  near  the  last,  and  sometimes 
they  are  derived  from  a common  trunk.  It  passes  between 
the  external  lateral  ligament  and  the  head  of  the  tibia, 
mounts  afterwards  towards  the  patella,  and  is  then  minutely 
ramified  on  the  lower  external  parts  of  the  knee  joint. 

The  upper  articular  arteries  anastomose  with  the  lower, 
and  also  with  the  anastomotic  and  the  long  branch  of  the 
external  circumflex. 

Below  the  knee,  the  popliteal  artery  is  over  the  popliteus 
muscle  and  between  the  heads  of  the  gastrocnemius.  Here 
it  sends  off  a large  branch  to  each  head  of  the  gastroc- 
nemius muscle,  (Arteriae  Gemellse)  and  small  irregular 
branches  to  the  other  muscles,  and  sometimes  the  nutritious 
artery  of  the  tibia. 

Generally  on  a level  with  the  aperture  of  the  interosseous 
ligament,  the  popliteal  artery  terminates  by  a division  into 


BLOOD-VESSELS. 


387 


two  large  branches,  the  Anterior  Tibia],  and  the  Posterior 
Tibial. 

The  Anterior  Tibial  Artery,  (Arteria  Tibialis  Ante- 
rior,) after  getting  through  the  interosseous  foramen,  passes 
down  the  leg  in  front  of  the  interosseous  ligament  and  in 
contact  with  it;  it  passes  also  over  the  middle  of  the  ankle- 
joint  to  the  dorsum  of  the  foot,  and  is  continued  in  a straight 
line  to  the  interval  between  the  metatarsal  bone  of  the  great 
toe,  and  of  the  one  next  to  it.  This  artery  is  situated  under 
a line  drawn  from  the  middle  anterior  part  of  the  head  of 
the  fibula,  to  the  middle  of  the  ankle  joint  in  front,  and  is 
continued  in  the  course  of  a line  drawn  from  this  latter 
point  to  the  junction  of  the  first  two  metatarsal  bones. 
Above,  it  is  placed  between  the  tibialis  anticus  and  the 
extensor  longus  digitorum  ; below,  on  the  leg,  between  the 
extensor  pollicis  and  the  tibialis  anticus,  and  while  en- 
gaged with  the  tendons  of  the  muscles  under  the  annular 
ligament  of  the  joint,  it  gets  to  the  fibular  side  of  the  tendon 
of  the  extensor  pollicis. 

The  anterior  tibial  nerve  adheres  to  it  its  whole  length. 

The  Anterior  Tibial  Artery  gives  off  several  branches. 

1.  The  Recurrent  Tibial,  (Tibialis  Recurrens)  pene- 
trates the  head  of  the  tibialis  anticus  muscle,  and  is  dis- 
tributed about  the  exterior  and  anterior  part  of  the  head  of 
the  tibia,  and  the  patella. 

2.  Several  small  arterial  twigs  are  then  sent  to  the  muscles 
and  periosteum  on  the  fore  part  of  the  leg,  but  they  have 
no  name. 

3.  The  Internal  Malleolar,  (Malleolaris  Interna) 
arises  from  the  anterior  tibial  near  the  joint,  it  passes  under 
the  tendon  of  the  tibialis  anticus,  and  is  distributed  to  the 
internal  ankle,  and  the  contiguous  part  of  the  foot. 

4.  The  External  Malleolar,  ( ATalleolaris  Externa) 
exists  most  commonly  as  two  small  branches,  one  arising 
on  a level  with  the  joint,  and  the  other  an  inch  or  two 
above.  They  pass  beneath  the  tendons  of  the  extensor 


388 


OF  THE  LOWER  EXTREMITIES, 


longus  and  the  peroneus  tertius,  to  the  lower  part  of  the 
fibula,  and  inosculate  with  the  peroneal  artery. 

5.  The  Tarsal  Artery,  (Arteria  Tarsea)  arises  from  the 
anterior  tibial  just  below  the  ankle  joint ; it  runs  outwardly 
under  the  tendons  and  the  belly  of  the  extensor  brevis,  to 
be  distributed  to  the  upper  outer  part  of  the  tarsus. 

6.  The  Metatarsal  Artery,  (Arteria  Metatarsea)  arises 
just  below  the  last,  and  is  distributed  by  many  branches  on 
the  upper  part  of  the  metatarsus.  A successful  injection 
demonstrates  a branch  of  it,  in  each  of  the  three  outer  in- 
terosseous intervals  of  the  metatarsal  bones  above. 

7.  The  Dorsal  Artery  of  the  Great  Toe,  (Dorsalis  Hal- 
lucis)  arises  from  the  anterior  tibial  at  the  root  of  the  first 
metatarsal  bone,  it  runs  in  the  superior  part  of  the  first 
metatarsal  interval,  and  terminates  in  two  branches,  which 
go  to  the  opposed  faces  of  the  great  toe,  and  the  second 
toe. 

After  this  the  anterior  tibial  artery  sinks  down  and  joins 
the  external  plantar  in  the  sole  of  the  foot. 

The  Posterior  Tibial  Artery,  (Arteria  Tibialis  Postica) 
extends  from  the  head  of  the  tibia  to  the  hollow  of  the  os 
calcis  ; it  is  on  the  tibial  side  of  the  leg,  and  is  placed  be- 
tween the  soleus  posteriorly,  and  the  flexor  digitornm 
anteriorly,  and  beneath  the  fascia  of  the  part.  It  is  dis- 
tributed in  the  following  manner: 

1.  The  Peroxeal  Artery,  (Arteria  Peronea)  arises  a 
little  below  the  commencement  of  the  posterior  tibial,  and 
is  extended  from  the  inferior  edge  of  the  popliteus  muscle 
to  the  external  ankle.  It  is  placed  at  the  tibial  edge  of  the 
fibula,  between  the  flexor  longus  pollicis  muscle  and  the 
external  edge  of  the  tibialis  posticus.  Its  situation  is  there- 
fore deep  and  of  difficult  access  in  the  living  body.  Aftei 
descending  along  two-thirds  of  the  fibula,  it  divides  into  an 
anterior  and  posterior  branch.  The  first  traverses  the  in- 
terosseous ligament,  and  descending  in  front  of  it,  is  rami- 
fied on  the  upper  external  part  of  the  foot.  The  second 


BLOOD-VESSELS. 


389 


descends  posteriorly  along  the  fibula,  and  is  distributed 
about  the  peroneo-tibial  articulation  and  the  adjacent  parts. 

2.  Several  small,  irregular,  muscular  and  cutaneous 
branches,  afterwards  arise  from  the  posterior  tibial  and  at 
its  upper  part,  most  commonly,  the  Arteria  Nutritia  Tibiae. 

At  the  ankle  the  posterior  tibial  is  at  the  internal  edge 
of  the  tendo  Achillas,  and  still  confined  by  the  fascia  of  the 
part.  It  passes  to  the  sole  of  the  foot  in  the  hollow  of  the 
os  calcis,  between  the  bone  and  the  abductor  muscle  of  the 
great  toe.  At  the  ankle  it  is  on  a line  with  the  internal 
margin  of  the  joint  behind,  and  in  contact  with  the  posterior 
malleolus,  between  the  tendon  of  the  flexor  longus  pollicis, 
and  that  of  the  flexor  longus  digitorum.  Having  got  to  the 
sole  of  the  foot,  it  terminates  by  dividing  into  two  branches, 
the  Internal  and  External  Plantar  Arteries. 

The  Internal  Plantar,  (Arteria  Plantaris  Interna,)  is 
the  smaller  of  the  two;  it  is  covered  by  the  abductor  pol- 
licis, and  passing  between  it  and  the  internal  inferior  margin 
of  the  foot,  it  terminates  at  the  anterior  end  of  the  first 
metatarsal  bone,  in  the  internal  digital  artery  of  the  great 
toe.  In  this  course,  it  sends  several  branches  to  the  con- 
tiguous parts  which  give  them  a high  degree  of  vascularity. 
One  of  the  most  remarkable,  is  given  off  about  the  os 
seaphoides,  and  cruizes  along  the  internal  margin  of  the  ab- 
ductor pollicis  to  its  anterior  end.  Another  makes  its 
appearance  superficially  in  the  sole  of  the  foot,  in  the  fissure 
between  the  abductor  pollicis  and  the  flexor  brevis  digi- 
torum, and  goes  as  far  forward  as  the  other. 

The  External  Plantar,  (Arteria  Plantaris  Externa,) 
inclines  towards  the  outer  margin  of  the  foot,  between  the 
flexor  brevis  digitorum  and  the  flexor  accessorius;  it  then 
advances  at  the  internal  edge  of  the  abductor  minimi  digiti 
to  the  root  of  the  metatarsal  bone  of  the  fourth  toe,  and 
makes  a curvature  forwards  and  inwards,  between  the  ten- 
dons of  the  flexor  longus  and  the  metatarsal  bones,  to  the 
first  metatarsal  interval,  where  it  is  joined  by  the  anterior 
tibial  artery  from  above.  This  sweep  forms  the  Plantar 


390 


OF  THE  LOWER  EXTREMITIES. 


Arch  (arcus  plantaris.)  The  distribution  of  the  External 
Plantar  is  as  follows: 

a.  Half  an  inch  from  its  origin,  it  detaches  backwards  and 
outwards  to  the  inferior  and  to  the  external  parts  of  the  heel, 
a multifideous  branch,  which  also  sends  an  arteriole  along 
the  external  edge  of  the  abductor  minimi  digiti. 

b.  At  the  root  of  the  fourth  metatarsal  bone  a branch  arises, 
called  the  External  Digital  Artery  of  the  Little  Toe,  which 
goes  first  along  the  internal  margin  of  the  muscles  of  this 
organ,  and  afterwards  at  the  head  of  its  metatarsal  bone, 
gets  between  them  and  the  bone,  and  is  distributed  along 
the  external  margin  of  the  little  toe. 

c.  The  Four  Digital  Arteries  come  next,  which  arise  suc- 
cessively at  the  fourth,  third,  second,  and  first  metatarsal 
intervals,  or  near  them,  from  the  convex  side  of  the  plantar 
arch.  They  get  forward  between  the  transversalis  pedis  and 
the  interosseous  muscles,  and  arriving  at  the  roots  of  the 
toes,  each  artery  bifurcates,  and  goes  to  the  opposed  sides 
of  the  adjacent  toes,  like  the  corresponding  arteries  of  the 
hand. 

The  Digital  Artery  that  supplies  the  great  toe,  and  the 
opposite  side  of  the  toe  next  to  it,  is  derived  from  the  united 
trunks  of  the  anterior  tibial  and  the  external  plantar.  At 
the  head  of  the  metatarsal  bone,  it  detaches  a branch  which 
runs  along  the  inner  edge  of  the  great  toe,  and  is  united,  by 
anastomoses,  with  the  internal  plantar  artery. 

OF  THE  VEINS  OF  THE  LOWER  EXTREMITIES. 

These  veins  like  those  of  the  upper  extremity,  are  super- 
ficial and  deep-seated.  The  more  important  of  the  firs!  are 
the  Saphena  Magna,  and  the  Saphena  Minor. 

1.  The  Saphena  Magna  arises  from  the  inside  of  the 
foot,  about  the  great  toe,  and  from  its  sole;  it  passes  in  front 
of  the  internal  ankle,  along  the  inside  of  the  leg,  over  the 
internal  condyle  of  the  os  femoris,  along  the  inner  front  part 


BLOOD-VESSELS. 


391 


of  the  thigh,  and  terminates  in  the  femoral  vein  just  below 
Poupart’s  ligament.  As  it  ascends,  it  collects  branches  from 
the  anterior  and  posterior  parts  of  the  lower  extremity.  It 
may  be  seen  very  readily  in  the  living  subject,  beneath 
the  skin. 

2.  The  Saphena  Minor,  is  also  readily  seen  through  the 
skin.  It  arises  from  the  external  superior  parts  of  the 
foot,  passes  behind  the  external  ankle,  and  ascends  on  the 
outside  of  the  leg  to  the  ham,  receiving  contributions  in  its 
course ; here  it  crosses  the  external  head  of  the  gastrocne- 
mius muscle,  and,  dipping  into  the  ham,  empties  into  the 
popliteal  vein. 

Frequent  anastomoses  occur  between  the  saphena  magna 
and  minor. 

The  origin  and  course  of  the  deep  veins  of  the  lower  ex- 
tremity, are  so  similar  to  the  distribution  and  course  of  the 
arteries,  that  a description  is  needless.  A venous  tube  al- 
ways attends  an  arterial  one,  being  in  contact  with  it,  en- 
closed in  the  same  sheath,  and  called  by  the  same  name. 
The  smaller  arterial  branches  in  the  leg  and  thigh,  have  each 
two  veins,  called  Venae  Comites. 

The  relative  situation  of  the  large  venous  trunks  is  im- 
portant. At  Poupart’s  ligament  the  femoral  vein  is  at  the 
inside  of  the  artery ; at  the  passing  of  the  adductor  tendon, 
the  vein  is  nearest  the  thigh  bone  ; and  in  the  ham,  the 
popliteal  vein  is  behind  the  artery,  and  consequently  more 
superficial. 


392 


OF  THE  LOWER  EXTREMITIES. 


SECTION  IV. 


Of  the  Nerves  of  the  Lower  Extremities. 

The  Nerves  of  the  Lower  Extremity  are  derived  from 
that  part  of  the  medulla  spinalis,  which  is  situated  in  the 
lower  dorsal  and  the  upper  lumbar  vertebrae.  The  lumbar 
nerves  form  a plexus  behind  the  psoas  magnus  muscle,  from 
which  proceeds  a cluster  of  nerves  to  supply  the  front  part 
of  the  lower  extremity,  including  both  its  skin  and  muscles. 
The  sacral  nerves  form  a plexus  in  the  pelvis,  at  the  side  of 
the  rectum,  from  which  proceeds  the  largest  nerve  in  the 
body,  the  Sciatic,  appropriated  to  the  supply  of  the  skin  and 
muscles  on  the  back  part  of  the  lower  extremity.  The 
lower  part  of  the  lumbar  plexus  is  continued  into  the  upper 
of  the  sciatic  or  sacral,  so  that,  under  a more  general  classi- 
fication than  what  is  adopted,  both  of  these  plexuses  may 
be  considered  as  forming  but  one. 

The  Plexus  Lumbalis  is  seen  by  dissecting  the  psoas 
magnus  muscle  from  its  origin,  and  turning  it  aside ; the 
primitive  nerves,  constituting  this  plexus,  sometimes  pass 
through  the  substance  of  the  muscle,  instead  of  going  be- 
hind it.  The  plexus  is  formed  by  the  four  upper  lumbar 
nerves,  with  a filament  from  the  last  dorsal.  The  anterior 
branches  only  of  these  nerves  are  concerned  in  forming 
it,  as  the  posterior  branches,  all  go  to  the  muscles  of 
the  back. 

In  the  distribution  of  this  plexus  to  the  lower  extremity', 
it  will  be  seen,  shortly  after  the  commencement  of  the  dis- 
section, that  its  branches  may  be  considered  under  two  di- 
visions ; first,  such  as  go  to  the  skin,  and  secondly,  such  as 
go  to  the  muscles. 


BLOOD-VESSELS. 


393 


A View  of  the  Lumbar  and  Ischiatic  Plexuses  and  the  Branches 
of  the  former. 

Fig.  71. 


1.  Tlie  Lumbar  Plexus. 

2.  The  Ischiatic  Plexus. 

3.3.  Abdomino-Crural  Nerves. 

4.  The  External  Cutaneous  Nerve  (Inguino-Cutaneous.) 
5.6.7.  Cutaneous  Branches  from 

8.  The  Anterior  Crural  Nerve. 

9.  The  Genito-Crural  Nerve,  or  Spermaticus  Externus. 
10.10,  The  lower  termination  of  the  Great  Sympathetic. 

11.  The  Iliacus  Internus  Muscle. 

12.  The  three  broad  Muscles  of  the  Abdomen. 

13.  The  Psoas-Magnus  Muscle. 

14.  Bodies  of  the  Lumbar  Vertebrae. 

15.  The  Quadratus  Lumborum  Muscle. 

16.  The  Diaphragm. 

17.  The  Sartorius. 


394 


OF  THE  LOWER  EXTREMITIES. 


From  the  upper  part  of  the  plexus,  fibrillse  pass  outwards 
and  downwards  over  the  quadratus  muscle ; some  of  their 
ramuscules  are  spent  on  the  sides  of  the  abdominal  muscles ; 
others  wind  over^he  crista  of  the  ilium  about  its  middle  part, 
and  are  distributed  to  the  integuments  of  the  hip. 

The  Spermaticus  Externus,  arises  also  from  the  upper 
part  of  this  plexus;  it  crosses  the  iliacus  internus  muscle, 
shaping  its  course  towards  the  anterior  superior  spinous 
process  of  the  ilium.  Here  it  involves  itself  in  the  edge  of 
the  abdominal  muscles,  and,  going  on  the  posterior  face  of 
Poupart’s  ligament,  at  the  internal  abdominal  ring,  it  joins 
the  spermatic  cord  of  the  male,  or  the  round  ligament  of  the 
uterus  of  the  female.  In  the  first  case  it  is  distributed  to  the 
spermatic  cord  and  scrotum;  in  the  second,  to  the  labium 
externum  and  mons  veneris. 

The  Cutaneus  Externus,  arises  from  the  lumbar  plexus 
below  the  external  spermatic.  It  passes  across  the  iliacus 
internus  towards  the  anterior  superior  spinous  process,  about 
an  inch  below  the  spermaticus  externus,  and  crosses  the 
latter  nerve,  just  at  that  process.  Emerging  from  the  ab- 
domen, by  penetrating  the  commencement  of  Poupart’s 
ligament,  it  is  distributed,  in  several  branches,  to  the  in- 
teguments of  the  vastus  externus  muscle,  and  along  the 
edge  of  the  rectus  femoris;  one  of  the  latter  extends  to  the 
patella. 

The  Cutaneus  Medius,  is  given  from  the  anterior  crural, 
an  inch  or  so  above  Poupart’s  ligament,  coming  from  it, 
among  the  cluster  of  branches  which  arise  there  to  be  dis- 
tributed to  the  iliacus  internus  muscle,  and  to  the  muscles 
of  the  thigh.  It  appears  superficially  on  the  thigh,  for  the 
first  time,  by  penetrating  the  sartorius  muscle,  about  the  in- 
ternal edge  of  the  rectus  femoris ; it  descends  then  along 
the  same  edge  of  the  latter  muscle,  and  is  distributed  to 
its  integuments.  It  does  not  descend  so  low  as  the  other 
nerve. 

The  Cutaneus  Anterior,  arises  also  from  the  crural 
nerve ; it  is  on  the  inner  side  of  the  cutaneus  medius, 
emerges  from  the  fascia  of  the  thigh,  and  crosses  the 
sartorius  muscle  two  or  three  inches  below  the  cutaneus 


NERVES. 


395 


medius.  It  is  distributed  on  the  integuments  of  the  vas- 
tus internus  muscle,  and  some  of  its  branches  extend  to 
the  internal  edge  of  the  patella. 

The  Cutaneus  Internus,  arises  from  the  anterior  crural 
nerve,  among  the  same  cluster,  above  Poupart’s  ligament. 
It  divides  into  four  or  five  branches  of  different  lengths,  and 
is  distributed  to  the  integuments  of  the  adductor  muscles  and 
along  the  inner  front  side  of  the  thigh.  One  branch  ob- 
serves, very  much,  the  course  of  the  tendon  of  the  adduc- 
tor magnus,  and  reaches  as  far  down  as  the  inner  side  of 
the  knee. 

The  Cruralis  Anterior,  arises  from  the  middle  of  the 
lumbar  plexus  ; at  first  it  is  beneath  the  psoas  magnus  mus- 
cle; it  then  gets  to  its  outside  and  passes  from  the  abdo- 
men, under  Poupart’s  ligament,  about  half  an  inch  from  the 
exterior  margin  of  the  femoral  artery.  Before  it  reaches 
Poupart’s  ligament,  it  gives  off  a cluster  of  nerves,  several 
of  which  go  to  the  iliacus  internus  muscle,  others  form  the 
superficial  or  cutaneous  nerves  of  the  thigh,  and  others  the 
deep-seated  or  muscular  branches.  The  distribution  of  the 
cutaneous  nerves  has  just  been  mentioned  ; the  muscular 
ones  supply  the  adductor  muscles,  the  four  extensors,  the 
pectineus,  the  sartorius,  and  the  gracilis. 

One  of  the  branches  of  the  anterior  crural  nerve  is  seen 
to  accompany  the  femoral  artery,  till  the  artery  penetrates 
the  adductor  magnus ; it  then  runs  along  the  front  margin 
of  the  tendon  of  the  adductor  magnus,  in  a channel  formed 
by  this  tendon  and  the  origin  of  the  vastus  internus.  The 
nerve  alluded  to  is  the  Saphenus  ; it  passes  afterwards  be- 
tween the  internal  condyle  of  the  os  femoris  and  the  sartorius 
muscle,  attaches  itself  to  the  saphena  vein,  and  is  distributed 
to  the  integuments  of  the  inner  side  of  the  leg  and  of  the 
upper  internal  parts  of  the  foot. 

The  Nervus  Obturatorius  is  derived  from  the  middle 
of  the  lumbar  plexus,  also,  and  has  very  much  the  same 
position  in  regard  to  the  psoas  magnus  as  the  anterior  crural 
nerve.  It  descends  from  beneath  the  psoas  magnus  into  the 
pelvis,  near  the  sacro-iliac  joint  and  passes  forwards  and 
downwards  to  the  obturator  foramen,  having  got  through 
which,  it  divides  into  an  anterior  and  a posterior  branch. 


396 


OF  THE  LOWER  EXTREMITIES. 


The  first  is  distributed  to  the  heads  of  the  adductor  longus 
and  brevis,  and  to  the  gracilis  and  integuments.  The 
second  terminates  in  the  obturator  externus,  and  the  adduc- 
tor magnus. 

The  Sciatic  Plexus,  (Plexus  Ischiadicus)  is  formed  by 
the  union  of  the  last  lumbar  with  the  four  upper  sacral 
nerves;  the  last  lumbar  before  it  joins  the  plexus,  receives 
the  branch  of  the  fourth  lumbar  nerve,  which  is  left  after  the 
lumbar  plexus  is  formed.  This  plexus  is  situated  at  the 
side  of  the  rectum,  before  the  pyrifoimis  muscle. 

The  sacral  nerves  amount  to  six  in  number,  sometimes 
only  to  five.  They  arise  from  the  lower  part  of  the  cauda 
equina,  and  pass  in  a very  oblique  direction  in  order  to  arrive 
at  the  sacral  foramina.  Like  the  other  nerves  of  the  spine,  they 
form  ganglions  by  the  union  of  their  anterior  and  posterior 
fasciculi,  and  then  pass  outwards  from  the  spinal  canal,  each 
one  by  an  anterior  branch  which  goes  through  the  foramen 
in  front  of  the  sacrum,  and  a posterior  branch  much  smaller, 
which  gets  through  the  foramen  on  the  back  of  the  sacrum. 
The  volume  of  the  posterior  branches  increases  till  the  fourth, 
but  the  fifth  and  the  sixth  are  much  smaller,  in  fact  only 
fibrillae.  These  posterior  branches  all  communicate  with 
each  other,  being  distributed  to  the  head  of  the  sacro-lum- 
balis  and  longissimus  dorsi,  to  the  posterior  edge  of  the 
glutseus  magnus,  to  the  integuments  of  the  buttock,  margin 
of  the  anus,  and  to  the  internal  parts  of  the  thigh. 

The  anterior  branches  of  the  sacral  nerves  are  much  larger 
than  the  posterior.  The  first  four  communicate  with  the 
sacral  ganglions  of  the  great  sympathetic,  besides  forming 
the  Ischiatic  plexus.  The  third  and  the  fourth,  assisted  by 
the  sympathetic,  form  the  Hypogastric  plexus.  The  fifth, 
and  the  sixth,  when  it  exists,  are  distributed  to  the  cocey- 
geus,  sphincter  and  levator  ani.* 

The  following  small  branches  are  sent  from  the  Sciatic 
plexus,  f 

* This  is  only  given  as  the  most  frequent  arrangement  of  the 
Sciatic  plexus,  and  of  the  branches  of  nerves  which  proceed  from  it ; 
other  arrangements  will  often  be  met  with  in  the  cavity  of  the  pelvis, 
in  which  not  so  many  sacral  nerves  are  sent  to  the  plexus,  and  the 
several  branches  proceeding  from  it,  depart  in  a different  manner. 

f They  sometimes  come  from  a common  trunk  called  the  small 
sciatic. 


NERVES. 


397 


a.  Nervi  Glutasi,  one  passing  through  the  upper  part  of 
the  sciatic  notch  along  with  the  artery,  to  the  glutseus  medius 
and  minimus,  the  other  below  the  pyriformis  muscle,  to  the 
glutseus  magnus. 

b.  Nervus  Pudendalis  Longus  Inferior,  which  passes 
under  the  tuber  of  the  ischium  to  the  glutseus  magnus, 
perineal  muscles,  urethra  and  integuments  of  the  penis,  and 
scrotum  in  men,  and  to  the  inferior  parts  of  the  labia  externa 
in  women. 

c.  Ramus  Femoralis  Cutaneus  Posterior.  This  nerve  is 
placed  between  the  integuments  of  the  thigh,  and  the  mus- 
cles which  arise  from  the  tuberosity  of  the  ischium.  It 
sends  many  branches  successively  to  the  skin  on  the  back  of 
the  thigh ; one  of  its  branches  longer  than  the  others  goes 
down  to  the  ham,  and  there  divides  into  several  filaments 
which  are  distributed  to  the  integuments  on  the  back  of  the 
leg. 

The  Nervus  Pudendalis  Superior  comes  from  the  third 
and  fourth  sacral,  occasionally  receiving  a contribution  from 
the  small  sciatic,  when  it  exists.  It  goes  in  company  with 
the  internal  pudic  artery  between  the  sacro-sciatic  ligaments, 
and  then  divides  into  two  branches ; the  inferior  of  which 
is  distributed  to  the  integuments  and  muscles  of  the 
perineum,  to  the  urethra  and  scrotum  ; the  superior  passing 
along  the  ramus  of  the  ischium  and  pubes  with  the  trunk  of 
the  internal  pudic  artery,  is  distributed  to  the  obturator  in- 
ternus,  accelerator  urinse,  urethra,  and  afterwards  getting 
between  the  symphysis  of  the  pubes  and  the  penis,  terminates 
on  its  integuments  and  the  glans  penis. 

The  Nervus  Ischiadicus,  or  the- great  Sciatic,  is  the  com- 
mon trunk  formed  from  the  sciatic  plexus ; it  is  much  the 
largest  nerve  in  the  body,  and  passes  from  the  pelvis  between 
the  pyriformis  and  the  geminus  superior  muscles.  It  crosses 
vertically  behind  the  small  rotator  muscles  of  the  thigh  ; 
being  concealed  by  the  inferior  edge  of  the  glutseus  magnus; 
it  is  there  about  half-way  between  the  tuberosity  of  the 
ischium  and  trochanter  major.  Thence  it  descends  on  the 
back  of  the  adductor  magnus  at  the  outer  edge  of  the  long 


398 


OF  THE  LOWER  EXTREMITIES. 


head  of  the  biceps  flexor  cruris.  About  half-way  down  the 
thigh,  sometimes  a little  lower,  the  Sciatic  nerve  divides  into 
the  Popliteal  or  Posterior  Tibial,  and  Peroneal  nerves. 
Occasionally  this  division  takes  place  as  high  as  the  exit  of 
the  nerve  from  the  pelvis,  but  in  this  case,  the  fasciculi  are 
parallel  with  each  other  as  far  as  the  middle  of  the  thigh. 
From  the  trochanter  minor  to  its  usual  place  of  division,  this 
nerve  is  parallel  with,  and  on  the  back  of  the  thigh  bone, 
but  there  the  two  branches  begin  to  diverge.  The  popliteal 
nerve  continues  straight  downwards  to  the  back  and  middle 
of  the  knee  joint,  and  to  the  interstice  between  the  heads  of 
the  gastrocnemius  muscle,  whereas  the  fibular  nerve  goes 
along  the  inner  posterior  edge  of  the  biceps  flexor  cruris, 
and  passes  between  its  tendinous  insertion  and  the  external 
head  of  the  gastrocnemius  muscle. 

Fig.  72. 


A View  of  the  Branches  of  the 
Ischi atic  Plexus  to  the  Hip  and 

RACK  OF  THE  THIGH. 

1.1.  Posterior  Sacral  Nerves. 

2.  Nervi  Glutei. 

3 The  Internal  Pudic  Nerve. 

4.  The  Lesser  Ischiatic  Nerve,  giving  off 

the  Perineal  Cutaneus,  and 

5.  The  Ramus  Femorulis  Cutaneus  Pos- 

terior. 

6.  Great  Ischiatic  Nerve. 


In  this  course  the  following  branches  are  sent  from  the 
sciatic:  Twigs  to  the  little  rotator  muscles  of  the  dtigh. 
The  Cutaneus  Internus  Superior,  which  arises  near  the  upper 


NERVES. 


399 


part  of  the  thigh,  and  is  distributed  to  the  skin  of  the  cor- 
responding part.  The  Cutaneus  Internus  Inferior,  which 
arises  just  below  the  last,  and  descending  upon  the  inner 
head  of  the  gastrocnemius  muscle,  is  distributed  to  the  in- 
teguments of  the  calf  of  the  leg.  A large  trunk  and  some- 
times instead  of  it,  distinct  branches  which  go  to  the  Ad- 
ductor Magnus,  Semimembranosus,  Biceps  and  Semitendi- 
nosus. 

The  Peroneal  Nerve,  (Nervus  Peroneus)  at  the  head  of 
the  fibula  divides  into  two  branches,  the  Peroneus  Externus 
and  the  Tibialis  Anterior ; but  before  this  division  it  sends 
a small  branch  to  the  external  parts  of  the  knee-joint,  and 
two  cutaneous  branches  called  Peroneo-Cutaneus.  The  in- 
ternal of  the  two  latter  descends  behind  the  external  head 
of  the  gastrocnemius,  and  at  the  bottom  of  the  leg  is  united 
to  a division  of  the  posterior  tibial,  called  the  External 
Saphenus  or  Communicans  Tibite.  The  external  branch  of 
the  peroneo-cutaneous  is  distributed  to  the  skin  along  the 
fibula. 

The  External  Peroneal  Nerve,  (Peroneus  Externus) 
gets  between  the  head  of  the  peroneus  longus  and  the  fibula, 
then  between  the  peroneus  longus  and  the  extensor  longus 
digitorum ; it  descends  at  the  outer  edge  of  the  last  muscle 
to  the  inferior  third  of  die  leg,  giving  out,  in  the  mean  time, 
many  muscular  branches.  Here  it  penetrates  the  aponeu- 
rosis and  divides  into  subcutaneous  branches,  which  supply 
the  lower  part  of  the  leg  and  the  upper  surface  of  the  foot 
andtoes.  This  nerve  is  called,  by  the  French,  the  Musculo- 
cutaneous of  the  leg. 

The  Anterior  Tibial  Nerve,  (Tibialis  Anterior)  gets  ob- 
liquely between  the  fibula,  the  peroneous  longus,  and  the 
extensor  longus  digitorum,  to  the  front  of  the  interosseous 
ligament,  where  it  accompanies  the  anterior  tibial  artery.  It 
passes  with  the  artery  under  the  annular  ligament  of  the 
ankle,  and  has  its  terminating  filaments  going  to  the  muse  e 
and  integuments  of  the  upper  surface  of  the  foot,  as  far  as 
the  end  of  the  first  two  toes.  One  of  its  branches  sinks 
down  with  the  anterior  tibial  artery  to  the  sole  of  the  foot. 
High  up  in  the  leg  it  gives  filaments  to  the  knee-joint,  and, 


400 


OF  THE  LOWER  EXTREMITIES. 


in  its  course  downwards,  it  furnishes  the  muscles  on  the 
front  of  the  leg. 

The  Posterior  Tibial,  or  Popliteal  Nerve,  (Xervus 
Popliteus)  having  the  direction  mentioned,  is  placed  be- 
tween the  skin  and  the  popliteal  vein.  It  gets  between  the 
heads  of  the  gastrocnemius  muscle,  and  perforates  the  ori- 
gin of  the  soleus,  going  with  the  posterior  tibial  artery,  be- 
tween this  muscle,  and  the  flexor  longus  digitorum  to  the 
bottom  of  the  leg.  It  gives  off 

a.  The  External  Saphenus,  (Saphenus  Externus,  or 
Communicans  Tibiae)  which  arises  above  the  knee  joint, 
and  descending  between  the  skin  and  the  gastrocnemius, 
turns  outwardly  and  anastomoses  with  the  cutaneous  branch 
alluded  to,  of  the  peroneal  nerve.  The  common  trunk  thus 
formed  passes  behind  the  external  ankle,  along  the  external 
margin  of  the  foot,  and  terminates  on  the  last  two  toes, 
having  given  off  a great  number  of  cutaneous  branches.  J 

b.  Branches  to  the  heads  of  the  gastrocnemius,  soleus, 
plantaris,  and  popliteus. 

c.  Branches  to  the  flexor  longus  digitorum,  tibialis  pos- 
ticus, and  to  the  flexor  longus  pollicis  pedis. 

d.  A branch  through  the  interosseous  ligament  above  to 
the  tibialis  anticus. 

e.  At  the  inferior  part  of  the  leg  many  cutaneous  fila- 
ments, one  of  which  gets  to  the  sole  of  the  foot. 

The  Posterior  Tibial  Nerve,  having  given  off  these 
branches,  divides  in  the  hollow  of  the  os  calcis  into  Internal 
and  External  Plantar  Nerves. 

The  Internal  Plantar,  (Plantaris  Internus)  proceeds 
along  with  the  tendon  of  the  flexor  muscle  of  the  great  toe. 
and  the  flexor  longus,  and  gives  filaments  to  the  contiguous 
muscles.  It  then  divides  in  such  a way  as  to  furnish  the 
two  sides  of  the  first  three  toes,  and  the  internal  side  of  the 
fourth. 

The  External  Plantar,  (Plantaris  Externus)  proceeds 
with  the  artery  of  the  same  name,  to  the  outer  edge  of  the 
foot,  between  the  flexor  brevis  digitorum  and  the  flexor  ac- 


NERVES. 


401 


cessorius.  It  is  distributed  to  the  two  sides  of  the  little  toe, 
and  to  the  external  side  of  the  fourth  toe.  One  branch  pe- 
netrates to  the  interosseous  muscles,  and  to  the  transversalis 
pedis.  A branch  of  considerable  size,  is  detached  near  the 
heel,  to  the  muscles  and  integuments  connected  with  the 
os  calcis.  k 


CHAPTER  I. 


OF  THE  LIGAMENTS  OF  THE  JOINTS. 


SECTION  I. 

Of  the  Ligaments  of  the  Head  and  Spine. 

The  Ligaments,  (Ligamenta)  properly  speaking,  are  those 
organs  which  tie  the  bones  together,  and  in  the  moveable 
joints  are  either  Capsular,  or  Funicular.  The  Capsular 
are  like  a bag,  open  at  both  ends,  at  either  of  which  the  arti- 
cular extremity  of  a bone  is  included,  and  are  much  more 
complete  in  some  joints,  than  in  others.  The  shoulder  and 
the  hip  joint  afford  the  most  perfect  examples  of  this;  in 
other  joints,  they  are  divided  into  irregular  fasciculi  of  fibres, 
permitting  the  synovial  membrane  to  appear  in  their  inter- 
stices, and  sometimes  they  are  still  more  widely  sepa- 
rated. 

The  Funicular  Ligaments  are  mere  cords,  extending 
from  one  bone  to  another : some  of  them  are  flattened,  some 
rounded,  and  others  oval,  or  cylindroid.  Their  names  are 
derived  either  from  their  position  or  shape,  and  are  gene- 
rally sufficiently  appropriate. 


404 


OF  THE  LIGAMENTS. 


OF  THE  SYNOVIAL  ARTICULAR  CAPSULES. 

Each  moveable  articulation  is  lined  by  a membrane,  re- 
flected over  the  internal  face  of  the  capsular  ligament,  and 
the  articular  cartilages.  This  membrane  is  a perfect  sac, 
and  unlike  the  capsular  ligament,  has  no  opening  in  it.  It 
is  remarkably  distinct  where  it  is  not  attached  to  the  articu- 
lar cartilages,  and  by  being  inflated,  is  caused  to  protrude 
in  small  vesicles  or  pouches,  between  the  fasciculi  of  the  li- 
gamentous structure.  Its  connexion  with  the  cartilages,  and 
its  continuation  over  them,  is  not  qoite  so  obvious,  and  re- 
quires more  management  to  demonstrate ; it  is,  indeed,  so  thin 
and  transparent  at  this  part,  and  adheres  so  closely,  that  its 
existence  has  been  questioned,  but  may  be  proved  in  a 
variety  of  ways,  as  by  maceration,  &c. 

The  Synovial  Sacs  have  on  their  outer  surface,  but  pro- 
jecting into  the  cavity  of  the  joint,  adipose  cushions  of  dif- 
ferent sizes,  called  the  Synovial  Glands  of  Havers,  from 
which,  till  lately,  it  was  supposed  that  the  lubricating  liquor 
of  the  joints  was  exclusively  secreted.  These  cushions 
have  their  projecting  margins  fringed,  are  unusually  vas- 
cular, and  occupy  the  small  spaces  left  between  the  articu- 
lar faces  of  the  bones.  As  they  are  covered  by  the  synovial 
membrane,  they  no  doubt  assist  in  the  secretion  of  the  sy- 
novia. 

The  moveable  articulations  are  all  furnished  with  the  fluid 
called  Synovia. 

This  name  was  given  to  it  by  Paracelsus,  from  its  resem- 
blance to  the  albuminous  portion  of  an  egg,  to  the  consist- 
ence and  colour  of  which  it  has  a close  affinity,  and  like  it 
is  thick,  ropy,  and  somewhat  yellowish.  It  is  secreted  from 
the  whole  internal  surface  of  the  synovial  membrane,  and, 
perhaps,  in  greater  quantities,  from  the  fringed  fatty  cushions 
in  the  joints,  in  consequence  of  their  increased  vascularity. 
Mr.  Beclard  believes  that  it  is  neither  a follicular,  nor  a 
glandular  secretion,  nor  a transudation ; hut  a perspi- 
ration, in  which  a perfect  equilibrium  is  kept  up  between  its 
exhalation,  and  its  absorption.  Its  use  is  to  diminish  fric- 
tion, and  consequently,  to  facilitate  the  sliding  of  the  bones 
upon  each  other. 


HEAD  AND  SPINE. 


405 


ARTICULATION  OF  THE  LOWER  JAW. 

This  articulation  is  formed  by  that  portion  of  the  glenoid 
cavity  anterior  to  the  fissure,  and  by  the  condyle  of  the  lower 
jaw.  Each  surface  is  covered  by  a thin  cartilage,  besides 
which,  there  is  an  inter-articular  cartilage,  and  two  synovial 
membranes,  in  addition  to  the  ligaments. 

The  whole  joint  is  invested  by  a capsular  ligament,  which 
arises  from  the  margin  of  the  glenoid  cavity  of  the  tempo- 
ral bone,  and  is  inserted  into  the  place  where  the  condyle 
and  neck  of  the  lower  jaw  unite.  This  ligament  has  also  an 
accumulation  of  fibres  internally  and  externally,  which  are 
called  the  Internal  and  External  Ligaments,  and  restrict 
somewhat  the  motions  of  the  jaw  forwards,  and  regulate  the 
position  of  the  vessels  and  nerves,  so  that  they  cannot  rea- 
dily be  displaced  and  injured,  by  the  various  motions  of 
the  part. 

By  cutting  open  the  capsular  ligament,  we  shall  see  the 
Inter-Articular  Cartilage,  interposed  between  the  gle- 
noid cavity  and  the  condyle,  having  its  upper  and  under  sur- 
faces accommodated  to  the  opposite  articular  surface  of  these 
parts.  The  two  distinct  synovial  membranes,  may  also  be 
seen,  one  passing  from  the  moveable  cartilage  to  the  gle- 
noid cavity,  and  the  other  from  the  lower  surface  of  the  car- 
tilage to  the  condyle.  The  cartilage  is  attached  by  its  cir- 
cumference to  the  internal  face  of  the  capsular  ligament. 

The  Stylo-Maxillary  Ligament,  arises  from  the  ex- 
ternal side  of  the  styloid  process,  and  is  inserted  into  the 
posterior  margin  of  the  jaw  near  its  angle,  between  the 
masseter  and  the  internal  pterygoid  muscles. 

The  stylo-glossus  muscle  is  much  connected  with  it,  and 
is  thereby  assisted  in  elevating  the  base  of  the  tongue ; the 
fascia  profunda  colli  is  also  in  continuation  with  it. 

OF  THE  LIGAMENTS  OF  THE  SPINE. 

Intervertebral  Substance. — Between  the  bodies  of  all 
the  vertebra  except  the  first  and  second,  a fibro-cartilaginous 


406 


OF  THE  LIGAMENTS. 


matter  is  placed,  which  is  fixed  to  their  bodies,  and  is  a very 
potent  means  of  union.  This  substance  is  more  fibrous  and 
hard  externally,  but  near  its  centre  it  is  of  a pulpy  consistence. 
A horizontal  cut  seems  to  demonstrate  it  asformedof  concen- 
tric fibres,  but  there  are  also  many  others  whose  course  is 
oblique,  and  irregular.  The  central  pulpy  part  is  confined 
by  the  other,  and  being  also  in  a state  of  compression,  it 
makes  an  articulation  in  some  degree  equivalent  to  the  ball 
and  socket  joint. 

The  Anterior  Vertebral  Ligament,  is  placed  on  the 
front  part  of  the  spine,  and  extends  from  the  second  verte- 
bra of  the  neck  to  the  first  bone  of  the  sacrum  inclusively. 
It  consists  of  longitudinal  white  fibres,  and  increases  gra- 
dually in  breadth,  from  its  commencement  to  its  termina- 
tion. It  adheres  very  closely  to  the  intervertebral  substance, 
and  to  the  edges  of  the  vertebras.  Where  much  motion  is 
admitted,  as  in  the  neck  and  loins,  it  is  thinner  than  on  the 
dorsal  vertebra. 

The  Posterior  Vertebral  Ligament,  is  placed  on  the 
posterior  part  of  the  bodies  of  the  vertebras  within  the  spinal 
canal.  It  arises  from  the  edge  of  the  foramen  magnum,  and 
passes  down  to  the  sacrum  and  os  coccygis,  adhering  to  the 
bodies  of  the  vertebra  and  to  the  intervertebral  substance. 
It  is  narrower  on  the  bodies  of  the  vertebra  than  on  the  in- 
tervertebral substance. 

Articulation  of  Oblique  Processes. — All  the  Oblique 
Processes  have  their  capsular  and  synovial  membranes,  and 
are  faced  with  caitilage  and  a synovial  capsule. 

Articulation  of  the  Spinous  Processes. — Ligamentous 
fibres  pass  also  between  all  the  spinous  processes,  except 
those  of  the  neck,  where  owing  to  the  shortness  of  the  pro- 
cesses, an  arrangement  exists  called  Ligamentum  Nucile, 
and  there  are  others  between  the  transverse  processes. 

This  Ligamentum  Nuchje  though  continuous  with  the  one 
just  described,  may  be  considered  for  the  sake  of  perspi- 
cuity as  distinct.  It  is  a tendinous  septum,  beginning  at 
the  spinous  process  of  the  seventh  cervical  vertebra,  and 


HEAD  AND  SPINE. 


407 


running  up  to  the  occiput,  where  it  is  fixed  into  its  vertical 
ridge  and  the  posterior  occipital  protuberance.  It  is  con- 
nected intermediately  to  the  spinous  processes  of  all  the 
vertebrie  above  the  seventh,  so  that  it  forms  a partition 
between  the  muscles  of  the  two  sides  of  the  neck.  In 
quadrupeds  it  is  remarkably  strong ; but  in  man,  wdio  from 
his  erect  position  keeps  the  head  nearly  balanced,  it  is  com- 
paratively feeble. 

Articulation  of  the  Bony  Bridges  of  the  Vertebrae. — 
The  intervals  between  the  vertebrae  and  the  posterior  part  of 
the  spinal  canal  are  filled  up  by  the  Yellow  Ligaments,  so 
called  from  their  peculiar  colour. 

There  are  twenty-three  pairs  of  them.  They  pass  be- 
tween the  adjoining  vertebrae,  one  on  each  side,  between 
the  spinous  and  oblique  process,  and  are  best  seen  from  the 
inside  of  the  vertebral  cavity.  The  first  pair  passes  from  the 
bony  bridge  of  the  second  vertebra  to  that  of  the  third,  and 
so  on  successively  to  the  sacrum.  They  are  very  elastic,  and 
assists  greatly  in  elevating  the  spine,  when  it  has  been 
curved  out  of  the  proper  line. 


PARTICULAR  ARTICULATIONS  OF  THE  SPINE. 

Articulation  of  Occiput  with  Atlas. — There  is  a cap- 
sular ligament  with  its  synovial  membrane,  which  surrounds 
on  either  side  the  superior  oblique  process  of  the  first  verte- 
bra, and  is  inserted  around  the  root  of  the  corresponding 
condyle  of  the  os  occipitis. 

The  condyles  and  processes  are  faced  with  cartilage. 

A circular  ligament,  (Ligarnentum  Occipito-Atloidien,) 
arises  from  the  whole  superior  margin  of  the  first  vertebra, 
and  is  inserted  into  the  margin  of  the  great  occipital  foramen. 

Articulation  of  the  Second  Vertebra  wtth  the  Occi- 
put and  with  the  First. — The  Second  Vertebra,  has  no 
articular  surface  joining  the  occiput,  but  some  strong  liga- 
ments are  passed  between  them.  The  Middle  Straight 
Ligament,  or  the  Occipito-Dentate,  passes  from  the  point  of 
the  processus  dentatus,  and  is  inserted  into  the  anterior  part 
of  the  margin  of  the  occipital  foramen. 


408 


OF  THE  LIGAMENTS. 


The  Moderator  or  Oblique  Ligaments,  are  two  in  num- 
ber, one  on  each  side  of  the  tooth-like  process,  and  arising 
from  the  lateral  margin  of  the  processus  dentatus;  they  are 
inserted  into  the  inner  margin  of  the  occipital  condyle. 

The  Transverse  Ligament  subtends  the  cavity  in  the  first 
vertebra,  for  the  reception  of  the  processus  dentatus.  The 
upper  edge  of  this  ligament  is  fixed  by  an  appendix  to  the 
foramen  magnum,  and  the  lower  edge  into  the  root  of  the 
processus  dentatus.  It  keeps  the  processus  dentatus  in  its 
place. 


SECTION  II. 


Of  the  Ligaments  of  the  Pelvis. 

The  mode  of  junction  between  the  sacrum  and  the  last 
lumbar  vertebra,  is,  in  every  respect  the  same  as  that  de- 
scribed for  the  bones  of  the  spine  generally,  with  the  addi- 
tion of  a ligament  on  each  side,  sometimes  met  with,  called 
Sacro-Vertebral,  which  arises  from  the  transverse  process 
of  the  last  lumbar  vertebra,  and  going  obliquely  downwards 
is  inserted  into  the  superior  part  of  the  sacrum  by  blending 
itself  with  the  anterior  fibres  of  the  sacro-iliac  junction. 

The  Sacrum  is  united  to  the  Coccyx,  by  a fibro-cartilagi- 
nous  substance  resembling  that  between  the  bodies  of  the 
true  vertebrae,  with  the  exception  of  their  being  less  pulpy 
matter  in  its  centre,  and  of  its  fibrous  lamellae  being  more 
uniform.  The  bones  of  the  coccyx  are  also  united  to  one 
another  in  the  same  way ; in  consequence  of  which  they  are 
very  flexible  till  the  approach  of  old  age. 

The  Anterior  Coccygeal  Ligament,  is  placed  on  the 
fore  part  of  the  coccyx,  runs  its  whole  length  and  arises  from 
the  inferior  extremity  of  the  sacrum.  Its  fibres  are  rather 
indistinct  from  being  blended  with  fat ; on  the  lateral  margins 
of  the  coccyx  they  are  better  marked. 


PELVIS. 


409 


The  Posterior  Coccygeal  Ligament  arises  from  the  in- 
ferior margin  of  the  spinal  canal  of  the  sacrum,  and,  con- 
tributing to  finish  the  canal  or  to  close  it  up,  is  then  dis- 
tributed on  the  back  of  the  os  coccygis  to  its  extremity. 

The  foramina,  on  the  posterior  part  of  the  sacrum,  are 
much  diminished  by  ligamentous  fibres  which  pass  in  every 
direction. 

The  Ilio-Lumbar  Ligament  arises  from  the  transverse 
and  inferior  oblique  process  of  the  last  lumbar  vertebra,  and 
going  outwards  towards  the  posterior  superior  spinous  pro- 
cess of  the  ilium,  is  inserted  into  the  adjoining  part  of  the 
crista.  It  is  much  mixed  with  fat.  Just  below  this  the 
Sacro-Spinous  Ligament  is  extended  between  the  poste- 
rior superior  spinous  process  and  the  third  and  fourth  trans- 
verse processes  of  the  sacrum. 

The  Sacro-Iliac  Ligament  is  an  assemblage  of  very  short, 
strong,  compact  fibres,  which  surround  this  articulation.  It 
is  connected  to  the  sacrum  by  its  transverse  processes  and 
by  the  rough  surface  just  on  the  iliac  side  of  it,  and  to  the 
ilium  by  the  rough  edge  just  behind  its  articular  surface  with 
the  sacrum.  In  front,  the  articulation  is  covered  by  short, 
strong  fibres. 

This  ligament  is  so  strong  that  in  forcing  the  joint  it  does 
not  rupture,  but  parts  from  the  surface  of  the  ilium  and  some- 
times brings  with  it  a lamella  of  bone. 

The  bones  of  the  pelvis  are  also  fastened  by  two  other 
very  strong  ligaments,  the  Sacro-Sciatic. 

The  Posterior  Sacro-Sciatic  Ligament  is  the  larger  of 
the  two,  and  arises  from  the  posterior  inferior  spinous  process 
of  the  ilium,  from  the  margin  of  the  sacrum  which  is  below 
it,  from  its  posterior  surface,  and  from  the  first  bone  of  the 
coccyx.  Its  fibres  converging,  it  becomes  thicker  in  the 
middle,  and  is  inserted  into  the  ridge  at  the  inner  margin  of 
the  tuberosity  of  the  ischium,  and  is  prolonged  towards  the 
pubes  by  a continued  attachment  along  the  inner  margin  of 
the  crus  of  the  ischium. 

The  Anterior  Sacro-Sciatic  Ligament  is  much  smaller 
than  the  other,  and  has  its  origin  somewhat  confounded  with 


410 


OF  THE  LIGAMENTS. 


that  of  the  posterior.  It  arises  from  the  margin  of  the  sacrum, 
and  somewhat  from  its  posterior  surface,  below  its  junction 
with  the  ilium,  and  from  the  side  of  all  the  bones  of  the  coc- 
cyx. Its  course  is  more  horizontal  than  that  of  the  poste- 
rior, and  its  fibres  converge  and  are  inserted  into  the  spinous 
process  of  the  ischium. 

The  two  sacro-sciatic  ligaments  supply  in  some  degree 
the  place  of  bone  and  form  a part  of  the  inferior  lateral 
parietes  of  the  pelvis.  They  convert  the  sciatic  notch  into 
a foramen  or  rather  form  with  it,  two  foramina ; the  upper 
and  larger  of  which  transmits  the  pyriformis  muscle,  the 
sciatic  nerve  and  the  gluteal  blood-vessels ; while  the  lower 
placed  between  the  insertion  of  the  two  ligaments,  transmits 
the  obturator  internus  muscle  and  brings  the  internal  pudic 
artery  into  the  pelvis. 

The  Articular  Surfaces  of  the  Sacrum  and  Ilium  are  covered 
each  with  its  appropriate  cartilage ; that  on  the  sacrum  is 
somewhat  thicker  than  the  one  on  the  ilium.  The  con- 
tiguous surfaces  of  these  cartilages  are  rough,  and  are  sepa- 
rated by  a yellow,  half-fluid,  tenacious  substance. 

The  Obturator  Ligament  is  extended  across  the  foramen 
thyroideum,  which  it  closes,  except  at  the  superior  part  where 
the  obturator  vessels  and  nerves  go  out.  It  is  also  frequently 
defective,  or  extremely  thin  below.  The  obturator  muscles 
arise  from  it. 

The  Articulation  of  the  Pubes  is  formed  between  the 
bodies  of  the  Ossa  Pubis,  and  consists  of  a fibro-cartilaginous 
matter  which  fills  up  the  space  between  them.  It  is  more 
fibrous  externally,  and  is  there  formed  of  concentric  lamellse 
which  surround  the  articulation.  In  men  there  is  more  of  this 
fibrous  matter  than  in  women ; in  the  latter,  we  frequently 
find  in  the  posterior  part  of  the  symphysis,  a little  flat  oblong 
cavity  occasioned  by  a distinct  plate  of  cartilage  on  each 
bone.  This  cavity  is  moistened  by  a white  or  yellowish 
fluid. 

From  frequent  observations  made  in  our  dissecting-rooms, 
I have  no  doubt  that  this  articulation  is  always  very  much 
relaxed  in  the  parturient  and  pregnant  female,  which  is 


THORAX. 


411 


manifested  not  by  the  bones  separating,  but  by  their  sliding 
upwards  and  downwards  with  great  readiness.  The  sacro- 
iliac junction  also  becomes  relaxed.  It  was  upon  the  ob- 
servation of  these  facts,  that  the  celebrated  but  now  exploded 
Sigaultian  operation  was  founded. 

The  Sub-Pubic  or  Inter-Pubic  Ligament,  is  a strong 
tendinous  membrane  of  half  an  inch  in  breadth,  occupying  the 
very  top  of  the  arch  of  the  pubes,  and  passing  from  one  bone 
to  the  other ; it  is  spoken  of  in  the  account  of  the  fascia  of 
the  pelvis. 

In  front  of  this  joint  there  are  several  other  fasciculi  of 
fibres,  which  get  collectively  the  name  of  the  Anterior  Pubic 
Ligament. 


SECTION  III. 

Articulations  of  the  Thorax. 

Posterior  Articulations  of  Ribs. 

The  articulations  of  the  bones  composing  these  joints 
being  double,  are  formed  between  the  heads  of  the  ribs  and 
the  bodies  of  the  vertebrae,  with  the  inter- vertebral  matter 
at  one  point,  and  between  the  tubercles  of  the  ribs  and  trans- 
verse processes  at  the  other.  In  either  case  the  respective 
surfaces  are  covered  by  articular  cartilage  and  have  a syno- 
vial membrane.  The  first  joint  is  the  Costo-Vertebral,  and 
the  second  the  Costo-Transverse. 

The  Costo-Vertebral  Articulation  presents  an  anterior 
ligament,  an  inter-articular  ligament,  and  two  synovial  mem- 
branes. The  Anterior  or  Radiating  Ligament  is  fixed 
as  its  name  expresses,  in  front  of  the  joint.  It  arises  from  the 
margin  of  the  head  of  the  rib  by  the  whole  breadth  of  the 
latter  and  diverging  towards  the  spine,  is  fixed  by  its  supe- 
rior fibres  into  the  vertebra  above ; by  its  inferior  fibres,  into 
the  vertebra  below,  and  by  its  middle  fibres,  into  the  inter- 


412 


OF  THE  LIGAMENTS. 


vertebral  substance.  The  inter-articular  ligament  passes 
from  the  ridge  on  the  head  of  the  rib,  to  a corresponding  line  of 
the  inter-vertebral  substance.  It  divides  the  articulation  of 
the  head  of  the  rib  into  two  cavities  which  have  no  commu- 
nication, and  it  is  in  consequence  of  the  latter,  that  there  are 
two  synovial  membranes. 

The  Costo-Transverse  Articulation,  has  in  addition  to 
the  joint  formed  between  the  tubercle  of  the  rib  and  the  end 
of  the  transverse  process,  several  ligamentous  fasciculi  which 
pass  in  varied  directions.  Its  synovial  membrane  is  much 
more  distinct  than  in  the  preceding  articulation  and  contains 
more  synovia.  There  are  a few  fibres  around  the  joint 
having  the  appearance  of  a capsule. 

The  Ligamenta  Transversaria  Interna,  arise  from  the 
inferior  margin  of  each  transverse  process  between  its  root  and 
externa]  extremity,  and  proceeding  downwards  and  inwards 
are  inserted  into  the  upper  margin  of  the  neck  of  the  rib 
below  ; its  fibres  run  obliquely  inwards.  The  Ligamenta 
Transversaria  Externa  arise  from  between  the  points  of  the 
transverse  processes  and  the  back  of  the  ribs  just  beyond 
their  tubercles,  their  fibres  go  outwardly. 

The  Ligamenta  Cervicum  Costarum  are  concealed  by, 
and  pass  between  the  back  of  the  neck  of  the  rib,  and  the 
front  of  the  corresponding  trafisverse  process.  To  be  seen, 
the  rib  must  be  sawed  through  in  its  length.  These  poste- 
rior articulations  all  require  a patient  dissection,  as  they  are 
surrounded  by  small  parcels  of  adipose  matter,  have  the  in- 
tercostal nerves  and  blood-vessels  in  contact  before,  and  the 
muscles  of  the  spine  behind. 

ANTERIOR  ARTICULATION  OF  THE  RIBS. 

At  its  anterior  extremity  there  is  a cavity  in  each  rib  into 
which  the  sternal  cartilage  fits  and  is  there  united.  This 
junction  is  strengthened  by  short  ligamentous  fibres  sur- 
rounding the  part  and  going  from  the  rib  to  the  cartilage, 
thus  presenting  an  Anterior  and  Posterior  ligament. 

The  cartilages  of  the  seven  true  tribs  run  into  pits  in  the 


THORAX. 


413 


sternum,  and  are  there  secured  by  the  radiated  ligaments 
which  lie  in  front  of  the  joints. 

The  Sternum  is  covered,  both  in  front  and  behind,  by  a 
strong  ligamentous  expansion  adhering  very  closely  to  it. 
From  the  second  bone  of  the  sternum  and  from  the  inferior 
margin  of  the  seventh  true  rib,  near  it,  a ligamentous  fasci- 
culus is  sent  to  the  cartilago  ensiformis,  and  is  called  the 
Costo-Xiphoid  Ligament. 


CHAPTER  II. 


OF  THE  ARTICULATIONS  OF  THE  UPPER 
EXTREMITIES. 

SECTION  I. 

Of  the  Sterno-  Clavicular  Articulation. 

The  Clavicle  and  the  Sternum  are  very  firmly  united  by 
the  breadth  of  their  articulating  surfaces,  and  by  the  thick- 
ness of  their  ligaments.  The  joint  is  invested  by  a thick 
fibrous  capsule,  the  anterior  portion  of  which  presents  a 
strong  fasciculus  of  fibres  somewhat  separated  by  small  in- 
terstices. This  portion  called  by  some  the  Radiated  Liga- 
ment, arises  from  the  front  of  the  internal  end  of  the  clavicle, 
and  is  inserted  around  the  margin  of  the  corresponding  part 
of  the  articular  surface  of  the  sternum.  The  capsular  liga- 
ment is  also  strengthened  on  its  posterior  surface,  by  additional 
fibres  sometimes  called  the  Posterior  Ligament. 

The  Inter-Clavicular  Ligament  is  closely  connected 
with  the  capsule  of  the  preceding  joint,  and  lies  on  the 
superior  end  of  the  sternum,  and  passes  from  one  clavicle 
to  the  other. 

The  Capsular  Ligament,  is  now  seen  to  proceed  from 
around  the  internal  end  of  the  clavicle,  and  is  inserted  into 
the  margin  of  the  articular  surface  of  the  sternum.  By  cut- 
ting it  open  we  find  that  there  is  a moveable  cartilage  inte:- 
posed  between  the  two  bones,  connected  below  with  the 
sternum,  above  with  the  clavicle,  and  by  its  margin  with  the 
internal  surface  of  the  capsular  ligament,  and  that  on  each 
side  of  this  cartilage  there  is  a distinct  synovial  membrane. 

The  Costo-Clavicular,  or  Rhomboid  Ligament,  arises, 


UPPER  EXTREMITIES. 


415 


from  the  upper  surface  of  the  cartilage  of  the  first  rib,  ascends 
obliquely  and  is  inserted  into  the  tubercle,  on  the  inferior 
face  of  the  clavicle,  near  the  sternum. 


Of  the  Scapulo-Clavicular  Articulation; 

These  exist  at  three  places ; the  first  by  a junction  be- 
tween the  acromion  scapulae,  and  the  external  end  of  the 
clavicle,  and  the  last  two,  by  ligaments  sent  from  the  cora- 
coid process  to  the  under  surface  of  the  clavicle. 

The  Acromio-Clavicular  Articulation  is  invested  by  a 
capsular  ligament  with  its  synovial  membrane,  which  unites 
the  acromial  end  of  the  clavicle  to  the  acromion  process.  This 
ligament  being  thickened  above  and  below,  these  parts  are 
called  the  Superior  and  the  Inferior  ligaments  ; occasionally 
a moveable  cartilage  is  also  found  in  this  joint. 

The  Coraco-Clavicular  Ligament  is  double,  one  part 
being  called  Conoid,  and  the  other  the  Trapezoid.  It  arises 
from  the  roughness  at  the  root  of  the  coracoid  process,  and 
is  inserted  into  the  tubercle  near  the  acromial  end  of  the  cla- 
vicle. The  conoid  having  its  base  upwards  is  inserted  into 
the  tubercle,  near  the  external  end  of  the  clavicle.  The 
conoid  and  the  trapezoid  ligaments  join  each  other  behind, 
at  an  angle  which  is  near  a right  angle ; they  are  both  very 
strong  and  fibrous. 

In  front  of  the  subclavius  muscle,  arising  from  the  root 
of  the  coracoid  process,  and  going  to  the  clavicle,  and  an- 
terior end  of  the  first  rib,  is  the  Ligamentum  Bicorne. 


Of  the  Scapular  Ligaments. 

The  Triangular  Ligament  of  the  Scapula  or  Coraco- 
Acromialis,  is  extended  over  the  shoulder  joint.  Its  base 
arises  from  the  whole  outer  margin  of  the  coracoid  process, 
and  its  apex  is  fixed  to  the  point  of  the  acromion  beneath  the 
clavicle.  It  is  thinner  in  the  middle  than  at  either  edge. 


416 


OF  THE  LIGAMENTS. 


The  Coracoid  Ligament  of  the  Scapula  is  stretched  across 
its  coracoid  notch,  and  converts  it  into  a foramen  for  the  ves- 
sels and  nerves. 


Of  the  Scapulo-Humeral  Articulation. 

The  Scapulo-Humeral  Articulation  is  formed  by  the 
glenoid  cavity  of  the  scapula,  and  the  head  of  the  os  humeri. 
As  usual,  each  articular  surface  is  covered  with  cartilage.  A 
capsular  ligament  arises  from  the  neck  of  the  former,  and  is 
inserted  into  the  neck  of  the  latter.  A fold  or  thickening  of 
it,  called  the  Accessory  Ligament,  (Ligamentum  Adsciti- 
tium)  passes  from  the  coracoid  process  towards  the  great  tu- 
berosity of  the  os  humeri. 

By  cutting  open  the  joint  we  see  the  synovial  membrane 
lining  its  cavity,  and  sending  a process  into  the  bicipital 
groove  of  the  os  humeri,  which  is  afterwards  reflected  along 
the  tendon  of  the  biceps  in  such  a way  as  to  keep  its  cavity 
entire.  This  tendon  is  connected  with  the  upper  margin  of 
the  glenoid  cavity,  and  also  with  the  fibrous  ring,  called  the 
Glenoid  Ligament,  which  surrounds  the  glenoid  ca\  ity,  and 
by  being  attached  to  its  edge  deepens  it. 


OF  THE  ELBOW  JOINT. 

The  Elbow’  Joint  has  a capsular  ligament  arising  from  the 
upper  margin  of  the  articular  surface  of  the  os  humeri  in- 
cluding its  sigmoid  cavities,  and  inserted  into  the  margin 
of  the  articular  surface  of  the  ulna,  and  into  the  coronary  li- 
gament of  the  radius.  This  capsule  has  additional  fibres 
internally,  and  externally,  called  Lateral  Ligaments,  or 
Brachio-Ulnar  or  Internal,  and  Brachio-Radial  or  Exter- 
nal. The  Internal  arises  from  the  internal  condyle,  ar.d 
spreads  in  a radiated  manner  to  be  inserted  into  the  inner 
edge  of  the  coronoid,  and  olecranon  process.  The  Exter- 
nal arises  from  the  external  condyle,  and  is  inserted  into  the 
coronary  ligament  of  the  radius. 

The  Coronary  Ligament  of  the  Radius  arises  from  one 


UPPER  EXTREMITIES. 


417 


side  of  the  sigmoid  cavity  of  the  coronoid  process  of  the 
ulna,  and  surrounding  the  neck  of  the  radius,  it  is  inserted 
into  the  other  side  of  the  same  cavity.  Its  upper  margin 
is  blended  with  the  capsular  ligament,  and  the  lower  is 
loosely  attached  to  the  root  of  the  neck  of  the  radius. 

On  the  anterior  and  posterior  surfaces  of  the  capsule  of 
the  elbow  joint,  there  are  small  and  irregular  fibres,  termed 
accessory  ligaments,  but  the  capsule  is  particularly  thin 
under  them,  in  order  to  accommodate  the  flexions  of  the 
joint. 

By  cutting  open  the  capsule,  we  see  the  extent  of  the  sy- 
novial membrane,  and  the  cartilaginous  surfaces  of  the  bones. 
At  the  bottom  of  the  greater  sigmoid  cavity  of  the  ulna,  a 
small  quantity  of  vascular  adipose  matter  is  found  traversing 
the  articular  cartilage,  and  interrupting  it. 

The  Interosseous  Ligament,  fills  up  the  space  between 
the  radius  and  the  ulna,  being  fixed  on  each  side  to  their 
sharp  edges.  It  is  composed  principally  of  oblique  fibres, 
which  pass  from  the  radius  to  the  ulna.  In  it  are  several 
perforations  for  blood-vessels,  one  particularly  large  is  just 
at  the  tubercle  of  the  radius. 

There  is  a small  ligamentous  band,  called  the  Round  Li- 
gament, at  the  upper  part  of  the  opening  for  the  vessels,  and 
which  goes  from  the  base  of  the  coronoid  process  of  the 
ulna  ta  the  radius,  just  below  its  tubercle. 

OF  THE  ARTICULATIONS  AT  THE  WRIST. 

Several  articular  cavities  present  themselves  at  this  point. 
One  is  between  the  lower  part  of  the  ulna,  and  the  radius, 
another  between  the  carpal  bones,  and  those  of  the  fore-arm, 
and  a third  between  the  two  rows  of  carpal  bones.  One  ge- 
neral capsule  invests  all  these  parts. 

The  Lower  Radio-Ulnar  Articulation  is  formed  into  a 
distinct  joint,  by  the  lateral  projection  of  the  articular  carti- 
27 


418 


OF  THE  LIGAMENTS. 


lage  of  the  radius,  between  the  ulna  and  the  cuneiform  bone. 
The  capsule  which  unites  this  joint  is  very  loose,  and  is 
hence  sdmetimes  called  the  Sacciform  Ligament. 

The  Radio-Carpal  Articulations  is  formed  between  the 
lower  end  of  the  radius  and  the  first  three  bones  of  the  up- 
per row  of  the  carpus.  A capsular  ligament  passes  from  the 
margin  of  the  cartilaginous  surface  of  the  radius,  and  from 
the  part  of  the  same  cartilage  which  is  continued  between 
the  ulna  and  the  cuneiform  bone,  and  is  inserted  into  the 
margin  of  the  articular  head,  formed  by  the  scaphoides,  lu- 
nare,  and  cuneiforme  bones. 

The  External  Lateral  Ligament  arises  from  tire  styloid 
process  of  the  radius,  and  is  inserted  into  the  scaphoid  bone, 
the  trapezium,  and  anterior  annular  ligament.  The  Internal 
Lateral  Ligament  arises  from  the  styloid  process  of  the 
ulna,  and  is  inserted  into  the  inner  side  of  the  cuneiform 
bone,  and  partly  into  the  pisiform  and  the  corresponding 
part  of  the  anterior  ligament,  which  confines  the  flexor 
tendons. 

By  cutting  open  this  articulation  we  see  the  synovial 
membrane  of  the  part,  and  a fold  of  it  called  by  some  writers 
the  Mucous  Ligament,  which  passes  from  between  the  sca- 
phoides and  lunare,  to  the  radius.  We  also  see  the  carti- 
lage of  the  radius  projecting  between  the  cuneiform  bone 
and  the  head  of  the  ulna,  and  forming  with  the  head  of  the 
ulna,  a distinct  joint,  as  stated. 

The  Articulation  between  the  First  and  the  Second  row  of 
carpal  bones  is  formed  by  a capsular  ligament,  which  goes 
from  the  first  to  the  second  row,  being  strengthened  laterally 
by  a multiplication  of  its  fibres,  constituting  lateral  liga- 
ments internally  and  externally ; the  fibres  of  the  capsular 
ligament,  and  of  the  radio-carpal  joint,  are  continued  into 
this.  There  are  also  several  fasciculi  of  fibres  which  run  in 
varied  directions,  some  oblique,  and  some  transverse, 
fastening  the  two  rows  together,  as  well  as  the  individual 
bones  of  the  same  row.  When  this  joint  is  opened  we  find 
but  one  synovial  membrane  for  the  two  rows  of  bones,  where 


UPPER  EXTREMITIES. 


419 


they  are  in  contact,  and  this  membrane  sends  in  digital  pro- 
cesses, between  the  lateral  surfaces  of  the  several  bones, 
which  are  opposite  to  each  other. 

There  are  strong  ligaments  which  go  from  the  carpal  to 
the  bases  of  the  metacarpal  bones,  but  owing  to  the  irregu- 
lar surfaces  of  these  bones,  but  little  motion  is  allowed,  al- 
though the  apparatus  of  articulation  is  complete,  with  its 
capsular  ligaments,  and  synovial  membranes.  The  meta- 
carpal bone  of  the  little  finger  has  more  motion  than  those 
of  the  other  fingers;  the  ring-finger  is  next;  the  middle  and 
fore-fingers  are  almost  stationary. 

The  Metacarpal  Bones  of  the  fingers  are  connected  to 
each  other  at  their  basis  by  transverse  ligamentous  fasciculi ; 
they  are  also  connected  at  their  heads  in  the  same  manner 
by  the  inferior  palmar  ligaments. 

A strong  capsular  ligament,  with  its  synovial  membrane, 
is  applied  to  the  articulation  between  the  trapezium  and  the 
thumb.  This  capsule  is  of  nearly  an  uniform  thickness, 
being  very  similar,  in  that  respect,  to  the  capsule  of  the 
shoulder  joint,  and  therefore,  admits  of  every  variety  of 
motion. 

Between  the  heads  of  the  metacarpal  bones  and  the  first 
phalanges,  there  is  a capsule  and  a synovial  membrane. 
The  capsule  being'  thickened  at  its  sides,  thus  forms  lateral 
ligaments.  In  front  it  has  a cartilaginous  thickening  which 
forms  a trochlea  for  the  flexor  tendon.  Behind,  it  is  im- 
perfect, the  principal  strength  being  derived  from  the  tendon 
of  the  extensor  muscle. 

The  Phalanges  are  articulated  in  the  same  way  with  each 
other,  that  they  are  articulated  with  the  metacarpal  bones; 
thus  they  have  an  Anterior  Ligament,  an  Internal  and  Ex- 
ternal Lateral  Ligament  and  a Synovial  Membrane. 


CHAPTER  III. 


OF  THE  ARTICULATION  OF  THE  LOWER 
EXTREMITY. 

SECTION  I. 

Of  the  Hip  Joint. 

The  Hip  Joint  is  formed  by  the  acetabulum  and  the  head 
and  neck  of  the  os  femoris,  which  parts  are  enclosed  in  a 
strong  capsular  ligament,  arising  on  the  outer  circumference 
of  the  margin  of  the  acetabulum,  and  inserted  into  the  root 
of  the  neck  of  the  os  femoris.  The  capsular  ligament  varies 
in  its  thickness  at  different  places  ; in  front  it  is  a fourth  of 
an  inch  thick,  internally  it  is  somewhat  thinner,  and  poste- 
riorly where  it  is  covered  by  the  quadratus  muscle,  it  is 
thinnest.  From  the  anterior  inferior  spinous  process,  acces- 
sory fibres  arise,  which  give  to  the  capsule  an  increased 
thickness  above,  but  its  strength  depends  principally  on  the 
muscles  which  surround  it. 

By  cutting  open  the  capsule,  we  see  that  its  internal  face, 
as  wrell  as  the  surfaces  of  the  bones,  are  covered  by  a deli- 
cate synovial  membrane  which  is  thrown  into  longitudinal 
folds  on  the  neck  of  the  os  femoris;  and  drat  a strong  liga- 
mentous cord,  passes  from  one  side  of  the  notch  in  the  lower 
part  of  the  acetabulum,  to  the  other,  leaving  an  opening  be- 
low for  the  introduction  of  vessels  into  the  cavity  of  the 
articulation. 

The  Ligamestum  Teres  arises  from  the  pit  in  the  head  of 
the  os  femoris,  and  seems  to  be  inserted  into  the  bottom  of 
the  acetabulum,  but  by  dissecting  the  synovial  membrane 


INFERIOR  EXTREMITIES. 


421 


from  it,  its  insertion  into  the  extremities  of  the  notch  of  the 
acetabulum  by  a bifurcated  termination,  and  into  the  inferior 
margin  of  the  cord  sub-tending  the  notch,  will  be  seen. 

The  depth  of  the  acetabulum  is  increased  by  the  Cotyloid 
Ligament,  which  surrounds  its  margin,  and  is  within  the 
origin  of  the  capsular  ligament.  A quantity  of  loose  vascu- 
lar, adipose  matter,  fdls  up  the  pit  in  the  bottom  of  the 
acetabulum,  and  is  covered  by  the  synovial  membrane.  By 
some  anatomists  it  is  called  the  Gland  of  the  Hip  Joint. 


OF  THE  KNEE  JOINT. 

The  Knee  Joint  is  formed  by  the  os  femoris,  tibia,  and 
patella.  The  fascia  of  the  lower  extremity  in  passing  from 
the  thigh  to  the  leg,  covers  this  joint  in  front,  as  far  back  as 
the  lateral  ligaments,  and  takes  the  place  of  a regular  cap- 
sular ligament.  It  is  there  called  Involucrum. 

The  External  Lateral  Ligament  arises  from  the  tube- 
rosity of  the  external  condyle,  and  is  inserted  into  the  head  of 
the  fibula.  The  Internal  Lateral  Ligament  arises  from  the 
tuberosity  of  the  internal  condyle,  and  is  inserted  into  the 
inner  side  of  the  head  of  the  tibia,  being  continued  for  some 
distance  down  the  edge  of  the  bone.  The  front  of  the  joint 
is  much  strengthened  by  the  ligament  of  the  patella  which 
passes  from  the  point  of  the  patella  to  the  tubercle  of  the 
tibia.  On  the  posterior  face  of  the  capsular  ligament,  is 
found  an  irregular  collection  of  fibres,  passing  obliquely  from 
the  upper  back  part  of  the  external  condyle,  to  be  inserted 
into  the  back  of  the  head  of  the  tibia ; these  constitute  the 
Ligament  of  Winslow. 

By  opening  the  joint  in  front  so  as  to  let  the  patella  fall 
upon  the  tibia,  a good  view  of  its  internal  arrangement  may 
be  obtained.  The  synovial  membrane  will  be  seen  arising 
from  the  cartilaginous  margin  of  the  head  of  the  tibia,  and 
around  that  of  the  patella  ; but  it  is  reflected  on  the  front 
and  sides  of  the  condyles  of  the  os  femoris,  half  an  inch  or 
more  above  the  margin  of  its  cartilaginous  surface.  On 


422 


OF  THE  LIGAMENTS. 


both  sides  of  the  ligament  of  the  patella,  and  between  it 
and  the  synovial  membrane,  a large  mass  of  fat  is  found, 
filling  up  the  vacuity  between  the  condyles  and  the  head 
of  the  tibia.  This  fat  projects  into  the  cavity  of  the  articu- 
lation, and  forms  on  each  side  of  the  patella  an  oblong 
ridge  covered  by  the  synovial  membrane.  It  is  called,  on 
the  external  side  of  the  patella,  the  Ligamentum  Alare 
Minus,  and  on  its  internal  portion,  the  Ligamentum  Alare 
Majus.  These  ligaments  terminate  each  in  a point  below 
the  patella,  where  they  are  in  contact  with  each  other;  and 
from  this  place  a duplicature  of  synovial  membrane,  ending 
on  the  crucial  ligaments,  and  on  the  os  femoris  between  its 
condyles,  is  extended  to  the  posterior  part  of  the  articula- 
tion and  is  called  the  Ligamentum  Mucosum. 

At  the  posterior  part  of  the  joint,  are  fixed  the  Crucial 
Ligaments,  two  in  number,  the  Anterior  and  the  Posterior. 
The  first  arises  from  the  internal  face  of  the  external  con- 
dyle, and  is  inserted  in  front  of  the  ridge  on  the  top  of  the 
tibia,  its  fibres  being  partially  blended  with  those  of  the 
semilunar  cartilages.  The  Posterior  arises  from  the  ex- 
ternal face  of  the  internal  condyle  of  the  os  femoris,  and  is 
inserted  into  the  head  of  the  tibia,  behind  the  ridge  on  its 
top,  some  of  its  fibres  being  blended  with  the  external 
semilunar  cartilage.  These  ligaments  are  exterior  to  the 
synovial  membrane. 

The  Semilunar  Cartilages,  two  in  number,  are  placed 
between  the  tibia  and  the  os  femoris;  to  see  them  well,  the 
last  bone  must  be  removed,  leaving  them  on  the  tibia. 
They  are  thick  at  their  exterior  circumference  and  are 
brought  to  a thin  edge  internally;  are  fastened  to  the  cap- 
sular and  the  lateral  ligament  by  their  outer  margin,  but  the 
internal  is  loose ; their  upper  and  under  surfaces  are 
covered  by  the  synovial  membrane.  The  internal  is  longer 
from  before  backwards  than  transversely,  and  is  semicircu- 
lar; the  external  is  almost  circular,  in  each  of  which  cases 
they  exactly  conform  to  the  corresponding  articular  surface 
of  the  tibia.  The  posterior  end  of  both  these  cartilages  is 
fixed  to  the  tibia,  between  the  spine  on  its  top,  and  the 
posterior  crucial  ligament ; their  anterior  ends  are  inserted 


INFERIOR  EXTREMITIES. 


423 


into  the  tibia  before  the  same  spine.  Occasionally  a trans- 
verse ligamentous  band  is  seen  to  unite  their  anterior 
extremities. 

The  height  to  which  the  synovial  membrane  ascends 
above  the  patella,  should  be  noticed  by  the  student,  as 
well  as  a large  bursa  just  behind  the  tendon  of  the  extensor 
muscles,  which  most  commonly  communicates  with  the 
joint. 

OF  THE  PERONEO-TIBIAL  ARTICULATION. 

The  head  of  the  fibula,  where  it  is  united  to  the  tibia, 
has  all  the  apparatus  of  a moveable  joint.  The  capsular 
ligament  is  thickened  in  front  and  behind,  which  occasions 
the  names  of  Anterior  and  Posterior  Ligament.  But  this 
joint  is  particularly  strengthened  by  the  insertion  of  the 
external  lateral  ligament  of  the  knee  and  by  the  tendon  of 
the  biceps  muscle. 

The  Interosseous  Ligament  fills  the  interstice  between 
the  two  bones.  It  is  attached  to  the  interosseous  ridges, 
which  lie  on  their  opposing  surfaces,  and  runs  the  greater 
part  of  their  length.  It  consists  of  oblique  fibres  descend- 
ing from  the  tibia  to  the  fibula,  and  forming  a thin  strong 
membrane.  Just  below  the  head  of  the  tibia,  it  is  perforated 
by  a large  foramen,  which  transmits  the  tibialis  posticus 
muscle  and  the  anterior  tibial  artery  and  vein ; lower  down 
it  has  several  small  foramina  for  blood-vessels,  and  near  the 
ankle  joint  it  is  perforated  also  by  the  fibular  artery. 

The  tibia  and  fibula  are  united  at  the  ankle  joint  by  tri- 
angular surfaces,  concave  on  the  part  of  the  tibia,  and  con- 
vex on  the  part  of  the  fibula.  These  surfaces  are  held  to- 
gether by  intermediate  ligamentous  matter,  as  well  as  a li- 
gament expanded  on  the  front  and  back  of  the  junction 
called  the  Anterior  and  the  Posterior  Ligaments.  The  car- 
tilaginous crust,  on  the  ends  of  the  tibia  and  the  fibula,  be- 
longing to  the  ankle  joint,  are  continued  for  a line  or  two, 
on  the  opposed  surfaces  of  the  tibia  and  the  fibula. 


424 


OF  THE  LIGAMENTS. 


OF  THE  ANKLE  JOINT. 

The  Ankle  Joint  is  formed  by  the  tibia,  fibula,  and  astra- 
galus. The  capsular  ligament  is  extremely  thin,  and,  in- 
deed, has  no  very  evident  existence  before  and  behind, 
excepting  a few  scattered  fibres.  The  fatty  matter  which  sur- 
rounds the  joint,  is  in  immediate  contact  with  the  synovial 
membrane,  and  protrudes  it  in  some  places,  inwards,  to- 
wards the  cavity  of  the  articulation. 


There  are  very  strong  lateral  ligaments  on  both  sides. 
The  Internal  Lateral  Ligament,  also  called  Deltoid,  arises 
from  the  inferior  extremity  of  the  malleolar  process  of  the 
tibia,  and  by  radiating  considerably,  is  inserted  into  the  les- 
ser apophysis  of  the  os  calcis,  and  into  the  internal  base  of  the 
astragalus.  The  External  Lateral  Ligament  is  divided 
into  three  fasciculi.  The  Anterior  arises  from  the  anterior 
part  of  the  end  of  the  malleolus  externus,  and  passes  obliquely 
forwards,  to  be  inserted  into  the  upper  and  outer  part  of 
the  astragalus.  The  Middle  fasciculus,  arises  from  the 
pointed  extremity  of  the  fibula,  and  descends  perpendicu- 
larly to  be  inserted  into  the  outside  of  the  os  calcis.  The 
Posterior,  comes  from  the  depression  in  the  extremity  of  the 
malleolus  externus,  and  passes  very  obliquely  to  be  insert- 
ed into  the  outer  back  part  of  the  astragalus. 

On  cutting  open  this  joint,  it  will  be  seen  that  the  syno- 
vial membrane  is  connected  to  the  several  bones  at  the  mar- 
gins of  the  cartilaginous  articular  surfaces. 


OF  THE  ARTICULATIONS  OF  THE  FOOT. 

The  Os  Calcis  and  the  Astragalus  are  united  by  ligaments 
investing  their  articulating  surfaces ; the  synovial  cap- 
sule belonging  to  their  posterior  surface  is  insulated,  but  the 
anterior  is  extended  into  that  which  unites  die  os  astragalus 
and  the  naviculare.  Between  the  two  bones  there  is  a very 


INFERIOR  EXTREMITIES. 


525 


strong  ligament,  the  Interosseous,  which  arises  from  the 
fossa  of  one,  to  be  inserted  into  the  fossa  of  the  other  ; it  is 
their  best  means  of  union. 

A small  ligament  called  the  Posterior  is  found  at  the  back 
of  this  joint. 

The  Synovial  Membrane  forms  a distinct  cavity  on  the 
posterior,  and  large  articular  surface  of  the  two  bones,  and 
is  in  contact  with  the  fatty  matter,  in  advance  of  the  tendo- 
achillo. 

The  Scaphoides  and  the  Astragalus  are  united  by  a 
capsular  ligament  with  its  synovial  membrane.  This  cap- 
sule is  thickened  by  additional  slips  above  and  internally; 
the  whole  arrangement  of  the  joint  is  such  as  to  admit  of 
much  motion. 

The  Os  Calcis  and  Cuboides,  besides  their  articular  car- 
tilage and  synovial  membrane,  form  a moveable  joint  with 
a very  strong  ligamentous  fastening,  called  the  Calcaneo- 
Cuboid  Ligaments.  The  Superior  arising  from  the  upper 
surface  of  the  os  calcis,  is  inserted  into  the  adjoining  part 
of  the  cuboides.  The  Inferior  one  is  much  the  strongest, 
and  consists  of  two  laminae,  of  which  the  superficial  is  the 
longest;  some  of  its  fibres  may  be  traced  to  the  basis  of 
the  outer  metatarsal  bone. 

A very  strong  ligament,  the  Inner  Calcaneo-Scaphoid, 
passes  from  the  interior  internal  part  of  the  os  calcis 
by  its  lesser  apophysis  and  is  fixed  into  the  inner  and  un- 
der surface  of  the  scaphoides.  This  ligament  supports 
the  astragalus. 

The  External  Calcaneo-Scaphoid  Ligament  passes 
from  the  greater  apophysis  of  the  Os  Calcis  below,  and  is 
fixed  to  the  outer  end  of  the  scaphoides. 

There  are  many  other  strong  ligaments  on  the  dor- 
sal and  plantar  surfaces  of  the  foot,  connecting  the  bones 


426 


OF  THE  LIGAMENTS. 


of  the  tarsus  together ; their  course  is  varied  and  com- 
plicated. 

The  Ligaments  of  the  Metatarsus  and  Phalanges  corres- 
pond nearly  with  those  of  the  metacarpus,  and  the  pha- 
langes of  the  fingers. 


PART  ¥. 

: ? 


OF  THE  DERMOID  COVERING. 

The  Dermoid  Covering  or  tissue  of  the  body,  consists  in 
the  Skin,  its  Sebaceous  Organs,  the  Nails  and  the  Hair. 

CHAPTER  I. 

SECTION  I. 


Of  the  Skin. 

The  Skin  (Pellis,  Cutis,  consists  of  the  Cuticle, 

Rete  Mucosum,  and  Cutis  Vera.  These  parts  are  easily 
separated  by  maceration ; also  by  boiling  or  immersion 
in  hot  water  for  a few  minutes,  and  immediately  after- 
wards throwing  the  section,  thus  heated,  into  cold  water. 
Yesicatories,  applied  to  the  living  body,  also  cause  the 
cuticle  to  detach  itself  from  the  Cutis  Yera. 

The  Cuticle  is  a very  thin  semitransparent  membrane, 
distributed  over  almost  the  whole  surface  of  the  body.  In 
some  parts,  as  on  the  palms  of  the  hands,  and  the  soles  of 
the  feet,  it  is  from  birth  much  thicker  than  in  others  ; and 
from  friction  and  pressure  in  after  life,  increases  farther 
in  its  proportionate  thickness.  The  cuticle  presents  every 


428 


OF  THE  INTEGUMENTS. 


where,  but  more  obviously  in  the  hands  and  feet,  a multi- 
tude of  furrows  caused  by  the  surface  of  the  cutis  vera, 
and  which  are  arranged  in  straight,  curved,  or  spiral  lines. 
It  adheres  to  the  cutis  vera,  and  is  perforated  by  the  ex- 
cretory orifices  of  the  sebaceous  organs  and  by  the  hairs, 
and  according  to  some  anatomists  by  the  origin  of  ab- 
sorbent and  exhalent  vessels.  The  perforations  are  best 
seen  on  the  nose,  ears,  and  external  parts  of  generation. 
From  the  internal  surface  of  the  cuticle,  processes  are 
sent  in,  which  line  the  different  foramina  of  the  cutis  vera. 
When  the  cuticle  is  raised  by  a blister,  these  processes 
become  collapsed,  bv  which  their  sides  are  approximated 
and  the  fluid  effused  beneath,  is  prevented  from  escaping. 

The  cuticle  has  but  little  elasticity,  no  vascularity,  and 
no  sensibility.  Its  use  seems  to  be  to  diminish  evapora- 
tion from  the  surface  of  the  body,  and  to  shield  the  pulpy 
terminations  of  the  nerves  of  the  cutis  vera. 

The  Corpus,  or  Rete  Mucosum,  is  the  second  layer  of 
the  skin,  and  on  it  depends  the  great  variety  of  colours 
observed  in  the  human  species.  It  covers  every  part  of 
the  cutis  vera,  but  is  not  so  obvious  beneath  the  nails,  and 
at  the  orifices  of  mucous  membranes.  Its  consistence  is 
mucilaginous,  from  which  its  name  is  derived. 

Mr.  Gaultier  states,  that  on  the  soles  of  the  feet  in  ne- 
groes, the  rete  mucosum  is  seen  to  be  disposed  in  the  fol- 
lowing manner:  1st.  On  the  inequalities  of  the  cutis  vera, 
next  to  its  papillae,  there  is  a layer,  which  he  calls  bloody 
pimples,  (bourgeons  sanguins)  but  which  in  the  opinion  ot 
other  anatomists,  are  only  the  papillae  of  the  cutis  vera. 
2d.  Next  to  them  is  a layer  called  Albida  Profunda,  on 
account  of  its  constant  colour  and  situation.  3d.  Then 
small  points,  constituting  a layer,  placed  over  the  last,  of 
a very  dark  brown,  in  negroes,  which  he  calls  Gemmula. 
And  4th,  a layer  adjacent  to  the  cuticle,  spread  over  the 
last,  and  called  Albida  Superficialis,  also,  from  its  colour 
and  position. 

In  cutting  through  the  skin  from  the  heel  to  the  toes,  at 
right  angles  to  its  furrows,  in  negroes,  this  arrangement 


OF  THE  SKIN. 


429 


may  be  readily  recognised.  And  in  cases  where  it  has 
been  rendered  indistinct  from  sickness  it  may  be  improved 
by  immersing  the  skin  for  three  or  four  days  in  lime  wrnter, 
a solution  of  potash  or  baryta,  and  afterw’ards  keeping  it 
the  same  length  of  time  in  a solution  of  corrosive  sublimate. 

The  existence  of  this  arrangement  of  the  rete  mucosum, 
may  be  established  in  other  parts  of  the  body  by  the  effects 
of  blisters.  The  Huids  being  thus  locally  attracted,  infiltrate 
the  rete  mucosum  and  separate  its  layers,  in  part,  so  as  to 
form  a vesicle,  frequently  very  thick,  particularly  in  fat 
persons. 

The  Cutis  Vera  gives  a covering  to  the  whole  body.  It 
consists  of  fibres  variously  blended,  and  running  in  every 
direction.  Its  blood-vessels  and  nerves  are  so  numerous 
that  the  prick  of  the  finest  needle  in  any  part  will  occasion 
pain  and  produce  blood.  Its  interior  surface  is  in  close 
connexion  with  the  subjacent  cellular  and  adipose  mem- 
brane, from  which  it  may  be  imperfectly  separated  by  dis- 
section.* The  cutis  vera  is  extremely  elastic.  Its  thick- 
ness varies ; on  the  back,  on  the  soles  of  the  feet,  and  on 
the  palms  of  the  hands  it  is  thicker  than  elsewhere.  On  the 
lips  and  on  the  margin  of  the  anus  and  vulva  it  is  very 
thin. 

The  cutis  vera,  on  its  external  face,  is  divided  by  nu- 
merous lines  running  in  different  directions.  When  the 
cuticle  is  removed,  this  surface  is  seen  to  be  studded  with 
small  filamentous  processes,  the  papillae  tactus,  w’hich  are 
extremely  sensitive  and  vascular.  They  are  very  obvious 
on  the  palms  of  the  hands  and  on  the  soles  of  the  feet, 
where  they  are  arranged  in  double  rows  on  the  ridges  of 
the  cutis  vera. 

* But  maceration  is  a much  more  complete  way  of  effecting  this 
separation. 


430 


OF  THE  INTEGUMENTS. 


SECTION  II. 


Of  the  Hair. 

The  Hair  grows  in  the  cellular  membrane  beneath  the 
skin.  It  is  best  studied  on  the  mustachios  of  the  larger 
animals,  as  the  horse,  ox,  &c.  Around  the  root  of 
each  hair  there  are  two  capsules,  one  within  the  other. 
The  internal  is  very  vascular.  In  the  root  of  the  hair  there 
is  a hollow  canal  filled  with  a pulpy  substance. 


SECTION  m. 

Of  the  Nails. 

The  Nails  are  a continuation  of  the  cuticle,  but  are  in- 
debted for  their  growth  to  their  adhering  by  their  roots  anu 
under  surface,  to  the  cutis  'vera.  If  they  are  torn  off  by 
pincers  or  separated  by  maceration,  their  form  and  origin 
may  be  readily  seen. 


SECTION  IV. 

Of  the  Sebaceous  Organs. 

These  consist  of  follicles  and  glands.  The  Follicles 
secrete  an  unctuous  fluid  which,  by  inspissation,  become* 
of  the  consistence  of  suet.  They  are  seated  in  the  skin, 
and  are  more  abundant  in  some  parts,  as  for  example,  on 
the  nose,  ears,  groins  and  external  parts  of  generation,  than 


OF  THE  SEBACEOUS  ORGANS. 


431 


in  others.  The  follicles  are  placed  also  around  the  roots 
of  the  hair  in  the  interior  of  the  capsules. 

The  Sebaceous  Glands  are  about  the  size  of  millet  seeds, 
and  are  placed  under  the  cutis  vera.  They  are  particularly 
numerous  under  the  skin  of  the  Mons  Veneris. 

The  recent  investigations  of  the  Dermoid  tissues  have 
enlarged  our  knowledge  of  their  structure  so  much  that  the 
present  account  can  only  be  regarded  as  an  outline.  To 
enter  more  fully  into  their  structure  would  be  incompatible 
with  the  arrangements  of  the  present  work,  and  those,  there- 
fore, who  may  desire  more  detailed  information  are  referred 
to  the  volume  on  Special  Anatomy  and  Histology. 


■ 

■ 


INDEX 


Page 


Abdomen,  173 

Abdominal  Aorta,  236 

Abdominal  Canal,  188  J 

Abductor  Indicis  Manus,  331 

Abductor  Indicis  Pedis,  380 

Abductor  Medii  Digiti,  381 

Abductor  Minimi  Digiti 
Pedis,  379 

Abductor  Minimi  Digiti 
Manus,  331 

Abductor  Pollicis  Pedis,  378  ] 

Abductor  Pollicis  Manus,  331 

Abductor  Tert.ii  Digiti,  381 

Accelerator  Urinae  muscle,  250 

Accessory  Ligament,  41G 

Acini  of  Liver,  21G 

Adductor  Brevis  muscle,  3-61 

Adductor  Digiti  Minimi,  381 

Adductor  Indicis  Pedis,  330 

Adductor  Longus  muscle,  361 

Adductor  Magnus  muscle,  361 

Adductor  Medii  Digiti,  331 

Adductor  Metacarpi  Mini- 
mi Digiti,  335 

Adductor  Pollicis  Pedis,  37  3 

Adductor  Pollicis  Manus,  331 

Adductor  Tertii  Digiti,  381 

Albida  Profunda,  423 

Albida  Superficialis,  423 

Alveus  Communis,  131 

Anastomosing  artery  of  fe- 
moral, 385 

28 


PAGE 


Anconeus  muscle,  319 

Anrpular  Ligaments,  325 

Annulus  Fossae  Ovalis,  160 

Ankle  Joint,  421 

Antitragus,  127 

Anterior  Auricular  muscle,  128 

Anterior  Chamber  of  Eye,  121 

Anterior  Ligament  of  Ute- 
rus, 266 

Anterior  Ligament  of  Blad- 
der, 255 

Anterior  Mediastinum,  235 

Anterior  Pubic  Ligament,  155 
Anterior  Sacro-Sciatic  Li- 
gament, 4 1 1 

Anterior  Tibial  Nerve,  399 

Anterior  Tibial  artery,  3;7 

Anterior  Vertebral  Liga- 
ment, 406 

Antitragicus  muscle,  128 

Antithelix,  127 

Aponeurosis  or  Fascia  Plan- 
taris,  376 

Aponeurosis  Palmaris,  332 

Aponeurosis  Pelvica,  255 

Appendicula  of  Ilyoides,  115 

Appendiculae  Epiploic®,  205 

Appendicula  Vermiformis,  210 

Aqueduct  of  Cotunnius,  131 

Aqueduct  of  Fallopius,  135 

Aqueduct  of  Fontana,  122 

Aqueous  Humour,  121 


434 


INDEX. 


PAGE 


Arbor  Vitae,  56 

Arcus  Superficialis,  345 

Areola,  273 

Arteries  of  Dura  Mater,  46 

Arteria  Anastomotica,  341 

Arteria  Centralis,  123 

Arteria  ad  Cutem  Abdomi- 
nis, 185 

Arteria  Dorsalis  Superior 
Scapulae,  339 

Arteria  Facialis,  97 

Arteria  Innominata,  285 

Arteria  Lingualis,  95 

Arteriae  Mammariae  Exter- 
na, 339 

Arteria  Maxillaris,  99 

Arteria  Occipitalis,  97 

Arteria  Pharyngea  Inferior,  97 
Arteria  Temporalis,  98 

Arteria  Thyroidea  Inferior,  102 
Arteria  Vertebralis,  64,  102 
Articulation  of  Lower  Jaw,  405 
Aryteno-Epiglottideusmus- 
cle,  150 

Arytenoid  Cartilages,  146 

Ary.tenoideus  obliquus  mus- 
cle, 149 

Arytenoideus  transversus 
muscle,  149 

Attollens  Auriculae  muscle,  128 
Axillary  artery,  338 

Axillary  plexus,  113 

Azygos  Uvulae,.  143 

Bal  1 of  Eye,  119 

Biceps  Flexor  Cubiti  mus- 
cle, 317 

Biceps  Flexor  Cruris,  366 

Bladder,  235 

Blood-vessels  of  Brain,  63 

Blood-vessels  of  Lower 
Extremities,  382 

Blood-vessels  of  Head  and 
Neck,  94 

Blood-vessels  of  Trunk,  285 

Blood-vesselsof  Upper  Ex- 
tremities, 338 

Brachial  artery,  338 

Brachialis  Externus,  319 

Brachialis  Interims,  318 


PAGE 

Brachio-Radial  Ligament,  416 


Brachio  Ulnar  Ligament,  416 

Bronchia;,  167 

Bronchial  arteries,  167,286 

Buccinator,  74 

Canal  of  Eustachius,  129 

Canal  of  Petit,  124 

Capsule  of  Glisson,  215 

Caput  Gallinaginis,  237 

Cardiac  Orifice,  207 

Carotid  Artery,  94 

Caruncul*  Myrtiformes,  115,265 
Cavitas  Innominata,  127 

Cauda  Equina,  69 

Centrum  Ovale,  50 

Cerebrum,  47 

Cerebellum,  55 

Cervicalis  Anterior,  102 

Cervicalis  Descendens  mus- 
cle, 307 

Cervical  Ganglions,  112 

Cervical  Nerves,  113 

Cervicalis  Posterior,  102 

Chorda;  Tendineae,  160 

Chorda  Tympani,  135 

Chorda;  Willisii,  44 

Ciliaris,  75 

Ciliary  arteries,  125 

Ciliary  Ligament,  122 

Ciliary  Stria;,  122 

Circumflexa  Anteriorartery,  340 
Circumfiexa  Ilii  artery,  294 

Circumflexa  Posterior  artery,  340 
Coccygeus  muscle,  251 

Cochlea,  133 

Ccecum,  210 

C celiac  Artery,  287 

Colon,  199 

Colnmna  Nasi,  137 

Column*  Came®,  160 

Columnsof  AbdominalRing,  177 
Columns  of  Rectum,  233 

Commissures  of  Cerebrum,  54 
Complexus  muscle,  308 

Compressor  Naris, 

Concha,  127 

Conoid  Ligament,  415 

Constrictor  IsthmiFaucium 
muscle,  142 


index. 


435 


PAGE 

Constrictor  Pharyngis  infe- 


rior muscle,  143 

“ “ medius,  144 

“ “ superior,  144 

Contents  of  Abdomen,  199 

Coraco-Brachialis  muscle,  318 
Coracoid  Ligament,  416 

Cornea,  121 

Corona  Glandis,  242 

Corroded  Preparations,  33 

Corpus  Callosum,  48 

Corpus  Cavernosum  Penis,  241 

Corpus  Ciliare,  122 

Corpus  Fimbriatum,  269 

Corpus  Highmorianum,  246 

Corpus  Pampiniforme,  248 

Corpus  Spongiosum  Ure- 
thras, 241 

Corpus  Spongiosum  Vagi- 
nae, 264 

Corpus  Striatum,  51 

Coronary  arteries,  164 

Coronary  Ligament,  213 

Coronary  Ligament  of  Ra- 
dius, 416 

Corpusculum  Aurantii,  161 

Corrugator  Supericilii,  73 

Costo-Clavicular  Ligament,  414 

Costo-Xiphoid  Ligament,  413 

Cotyloid  Ligament,  421 

Cowper’s  Glands,  238 

Cuticle,  427 

Clitoris,  262 

Cranium,  Integuments  of  41 

Cremaster  muscle,  183,  245 
Cribriform  fascia,  196 

Crico-Arytenoideus  Posti- 
cus, 148 

Crico-Arytenoideus  Latera- 
lis, 149 

Cricoid  Cartilage,  146 

Crico-Thyroideus  muscle,  148 
Crural  Arch,  177 

Crura  of  Diaphragm,  229 

Crural  Ring,  196 

Cruralis  Anterior  nerv.e,  395 

Cruraeus  muscle,  359 

Crucial  Ligaments,  422 

Crystalline  Humour,.  123 


PAGE 


Cupola,  133 

Cutaneus  Anterior  nerve,  394 

Cutaneus  Externus  nerve,  394 

Cutaneus  Internus  nerve,  395 

Cutaneus  Medius  nerve,  394 

Cutis  Vera,  429 

Cystic  Duct,  219 

Dartos,  244 

Dorsalis  Carpi  artery,  342 

Dorsalis  Manus  artery,  344 

Dorsalis  Hall ucis  artery,  388 

Deltoid  ligament,  424 

Deltoid  muscle,  314 

Depressor  Anguli  oris,  74 

Depressor  Lahii  Inferioris,  74 
Depressor  Labii  Superioris 
Aleeque  nasi,  74 

Decendens  Noni,  111 

Diaphragm,  227 

Digastricus,  85 

Ductus  Communis  Chole- 
docus,  219 

Ductus  Ejaculatorius,  240,  248 
Ductus  ad  Nasum,  137 

Ductus  Stenonianus,  92 

Ductus  Whartonianus,  93 

Ductus  Wirsungii,  222 

Duodenum,  208 

Dura  Mater,  43 

Ear,  126 

Elbow  Join,  416 

Eminentiag  Mamillares,  59 

Em  ill  gent  arteries,  224,  289 

Encephalon,  42 

Epididymis,  24? 

' Epigastric  artery,  294 

Epigastric  region,  173 

Epiglottis  Cartilage,  147 

Erector  Penis  muscle,  249 

Eustachian  Valve,  160 

Excretory  Duct  of  Kidney,  225 
Extensor  Brevis  Digito- 
rum  Pedis,  375 

Extensor  Carpi  Radialis 
Brevier,  328 

Extensor  Carpi  Radialis 
Longior,  327 


436 


INDEX. 


Extensor  Carpi  Ulnaris, 
Extensor  Digitorum  Com- 
munis, 

Extensor  Longus  Digito- 
rum Pedis, 

Extensor  Major  Pollicis 
Manus, 

Extensor  Minor  Pollicis 
Manus, 

Extensor  Ossis  Metacarpi 
Pollicis, 

Extensor  Proprius  Pollicis 
Pedis, 

External  Abdominal  Ring, 
External  Ear, 

Exter.  Calcaneo-Scaphoid 
Ligament, 

External  Carotid, 

External  Circumflex, 
External  parts  of  Head  and 
Neck, 

External  Iliac  artery, 
External  Jugular, 

External  Lateral  Ligament 
of  Wrist, 

External  Lateral  Ligament 
of  Knee, 

External  Malleolar  artery, 
External  Plantar  artery, 
External  Plantar  nerve, 
External  Pudic  artery, 

Eye, 

Falciform  Ligament, 
Fallopian  Tubes, 

Falx  Major, 

Fascia  Fern  oris, 

Fascia  Iliaca, 

Fascia  of  Lower  Extremi- 
ties, 

Fascia  Profunda  Cervicalis, 
Fascia  Profundi  Colli, 
Fascia  Superficialis, 

Fascia  Superficialis  Colli, 
Fascia  of  Upper  extremities, 
Fauces, 

Female  Mamma?, 

Female  Organs  of  Genera- 
tion, 


PAGE 


Female  Pelvis,  260 

Femoral  Canal,  198 

Fissura  Vulva;,  261 

Flexor  Accessorius  muscle,  377 
Flexor  Brevis  Digitorum 
Pedis,  377 

Flexor  Brevis  Minimi  Di- 
giti  Pedis,  380 

Flexor  Brevis  Pollicis  Ma- 
nus, 333 

Flexor  Brevis  Pollicis  Pe- 
dis, 370 

Flexor  Digitorum  Profun- 
dus, 323 

Flexor  Digitorum  Subli- 
mis,  322 

Flexor  Longus  Pollicis,  323 

Flexor  Longus  Digitorum 
Pedis,  373 

Flexor  Manus  vel  Carpi 
Ulnaris,  321 

Flexor  Longus  Pollicis  Pe- 
dis, 374 

Flexor  Manus  vel  Carpi 
Radialis,  321 

Flexor  Parvus  Minimi  Di- 
giti  Manus,  334 

Foramen  Caecum  of  Mor- 
gagni, 141 

Foramen  Rotundum  of  Ear,  129 
Foramen  (Esophageum,  227 

“ Quadratum,  228 
Foramen  of  Monro,  53 

Foramen  Ovale  of  ear,  129 

Foramen  of  Soemmering,  123 

Foramina  Thebesii,  169 

Foramen  of  Winslow,  203 

Fornix,  51 

Fossa  Navicularis,  243 

Fossa  Ovalis,  160 

Fourchette,  261 

Gall-Bladder,  218 

Gastric  artery,  287 

Gastrocnemius  muscle,  371 

Gemmula,  428 

Gemini  muscles,  364 

Genio-Hyo-Glossus,  87 

Genio-Hyoideus,.  87 


PAGE 

328 

328 

368 

330 

330 

330 

368 

177 

128 

425 

95 

384 

41 

294 

102 

418 

421 

387 

389 

400 

383 

114 

212 

259 

43 

194 

195 

355 

81 

81 

187 

79 

313 

141 

271 

269 


INDEX. 


437 


PAGE 

Gimbernat’s  Ligament, 

177 

Glands  of  Brunner, 

209 

Gians  Penis, 

Glandulat  Labiales  et  Buc- 

242 

eales, 

141 

Glands  of  Meibomius, 

114 

Glands  of  Tyson, 

242 

Glenoid  Ligament, 

416 

Glosso-Pharyngeal, 

110 

Glottis, 

150 

Gluteal  artery, 

293 

Gluteus  Magnus, 

362 

Gluteus  Medius, 

362 

Gluteus  Minimus, 

363 

Gracilis, 

360 

Hair, 

430 

Hamulus, 

lb  3 

Head  and  Neck, 

41 

Heart, 

158 

Helix, 

127 

Helicis  Major  muscle, 

128 

Helicis  Minor  muscle, 

123 

Hepatic  Artery,  217,287 

Hepatic  Duct, 

216 

Hernia, 

193 

Key's  Ligament, 

198 

Hiatus  Aorticus, 

228 

Hippocampus, 

51 

Humours  of  the  Eye, 

123 

Hyo-Glossus, 

88 

Hypoglossal  nerve, 

63 

Hypogastric  artery. 

290 

Hypogastric  region, 

173 

Hymen. 

264 

Ileo-Colic  Valve, 

211 

Ileo-Colic  artery, 

289 

Ileum, 

209 

Iiiacus  Internus  muscle, 

238 

Ilio-Lumhar  artery, 

291 

Ilio-Lumbar  Ligament, 

409 

Incus, 

Indicator  muscle, 

130 

331 

Infundibulum,  59 

Inferior  Maxiliary  nerve, 

, 225 

107 

Inferior  Mesenteric  artery, 

290 

Infra-Spinatus  muscle, 

316 

Inter-Clavicular  Ligament, 
29 

414 

PAGE 


Itercostals,  154 

Intercostal  arteries,  286 

Intercosto-humeral  nerves,  353 

Internal  Abdominal  Ring’,  188 

Internal  Caleaneo-Scaphoid 

Ligament,  4 '2 5 

Internal  Carotid,  100 

Internal  Circumflexa  artery,  384 

Internal  Iliac  vein,  295 

Internal  Jugular,  103 

Internal  Lateral  Ligament 
of  Wrist,  418 

Internal  Lateral  Ligament 
of  Knee,  421 

Internal  Malleolar  artery,  387 

Internal  Mammary  vein,  295 

Internal  Mammary  artery,  285 

Internal  Plantar  nerve,  400 

Internal  Plantar  artery,  3S9 

Internal  Pudie  artery,  293 

Interossea  Artery,  344 

Inter-Pubic  Ligament,  254 

Interosseous  Ligament  of 
fore-arm,  417 

Interosseous  Ligament  of 
Leg,  423 

Interossea  anterior  artery,  344 

Interossea  posterior  artery,  344 

Interosseus  Digiti  Auricu- 
laris,  S3  6 

Inter-Spinales  muscles,  310 

Injections,  19 

Inter-Transversarii  muscles,  310 
Intestinal  Canal,  208 

Involucrum,  359,  421 

Iris,  122 

Isthmus  of  Fauces,  142 

Ischiatic  artery,  293 

Jejunum,  209 

Joints  at  Wrist,  417 

Kidneys,  223 

Knee  Joint,  421 

Labia  Externa,  261 

Labia  Interna,  262 

Labyrinth,  133 

Lachrymal  Gland,  116 


438 


IXDEX. 


PAGE 


Lachrymal  Sac  and  Ducts,  115 

Lamina  Spiralis,  133 

Large  Intestine,  210 

Laryngeal  Nerves,  111 

Larynx,  1 45 

Lateral  Half  Arches  of 
fauces,  141 

Lateral  Ligaments  of  Ute- 
rus, 2G6 

Lateral  Nasal  Nerve,  107 

Lateral  Sacral  arteries,  291 

Lateral  Ventricles,  .50 

Latissimus  Dorsi,  301 

Laxator  Tympani  muscle,  132 

Left  Gastro-Epiploic  artery,  247 

Left  Auricle,  162 

Left  Lumbar  region,  173 

Left  Ventricle,  163 

Left  Lateral  Ligament,  213 

Left  Hypochondriac  region,  173 

Left  Iliac  Tegion,  173 

Levator  Ani  muscie,  254,  257 
Levator  Anguli  Oris,  73 

Levator  Labii  Inferioris,  76 

Levator  Labii  Superioris 
Aleeque  Nasi,  73 

Levator  Palati,  142 

Levator  Scapulae  muscle,  304 

Levatores  Costaruin  mus- 
cles, 311 

Ligamentum  Alare  Majus,  422 
Ligamentum  Alare  Minus,  422 
Ligamentum  Arcuatum,  229 
Ligamentum  Bicorne,  415 
Ligamenta  Cervicum  Cos- 
tarum,  412 

Ligaments  of  Foot,  424 

Ligaments  of  Head  and 
Spine,  407 

Ligaments  of  Head  and 
Trunk,  405 

Ligamentum  Nuchae,  406 

Ligaments  of  Inferior  Ex- 
tremities, 420 

Ligamentum  Patella;,  359 

Ligaments  of  Pelvis,  408 

Ligament  of  Poupart,  177 

Ligamentum  Pulmonis,  165  j 

Ligaments  of  Spine,  405 


PAGE 


Ligamentum  Suspensorium 
Penis,  240 

Ligamentum  Teres,  420 

Ligaments  of  Thorax,  411 

Ligamenta  Transversaria 
Interna,  412 

Ligaments  of  Upper  Extre- 
mities, 414 

: Ligament  of  Winslow,  421 

j Linea  Alba,  176 

Linea  Semilunaris,  176 

; Line®  Transversae,  176 

i Lingualis,  88 

Lingual  Nerve,  108 

Liver,  199,212 

Lobus,  126 

Lobulus  Anonvmus,  213 

Lobulus  Caudatus,  213 

Lobulus  Spigelii,  213 

Longissimus  Dorsi  Muscle,  306 
j Longus  Colli,  88 

Lower  Extremities,  355 

Lower  Hemorrhoidal  Ar- 
tery, 293 

Lumbar  Arteries,  290 

Lumbricales  muscles,  332 

Lumbricales  Pedis  mus- 
cles, 378 

Lungs,  165 

Lymphatic  Glands  of  Neck,  93 

Magna  Pollicis  artery,  313 

Malleus,  129 

Male  Pelvis,  232 

Masseter,  76 

Meatus  Auditorius  Exter- 
nus,  126 

Medulla  Oblongata,  56 

Mediastinum,  155 

Median  Basilic  vein,  316 

Median  Cephalic  vein,  346 

Membrane  of  Jacobs  or  T u- 
nica  Jacobi,  122 

Membrana  Pupillaris,  122 

1 Membranousportion  of  Ure- 
thra, 243 

Membrana  Tympani,  129 

Mesentery,  205 

Mesocolon,  206 


INDEX. 


439 


Metatarsal  artery, 
Middle  Hemorrhoidal, 

PAGE 

388 

Nerves  of  Orbit, 

PAGE 

125 

291 

Nervus  Pudendalis 

Supe- 

Middle  Thyro-Hyoid  Liga- 

rior, 

397 

ment, 

Middle  Sacral  artery, 

147 

Nervus  Radialis  or  Muscu- 

290 

lo  Spiralis, 
Nervus  Scapularis, 

351 

Mitral  Valve, 

163 

348 

Moderator  Ligaments, 

408 

Nervi  Subscapulares 

348 

Modiolus, 

133 

Nervi  Thoraciei, 

349 

Mons  Veneris, 

261 

Nervus  Trigeminus, 

105 

Motores  Externi, 

62 

Nervus  Trochlearis, 

61 

Motor  Externus, 

61 

Nervus  Ulnaris, 

352 

Mouth, 

139 

Nerves  of  tipper  Extremi- 

Mucous  Ligament  of  Wrist, 

418 

ties, 

348 

Muscles  of  Abdomen, 

175 

Nerves  and  Vessels  of 

Muscles  of  Back, 

299 

Trunk, 

275 

Muscles  of  Eye, 

116 

Nipple, 

273 

Muscles  of  Face, 

70 

Nose, 

136 

Muscles  of  Foot, 

375 

Nutritia  Arteria, 

341 

Muscles  on  Back  of  Fore- 

Nymph  ae, 

262 

Arm, 

327 

Muscles  in  Front  of  Fore- 

Obliquus  Capitis  Superior 

Arm, 

Muscles  of  Leg, 

320 

muscle, 

310 

367 

Obliquus  Capitis  Inferior 

Muscles  of  Lower  Extremi- 

muscle. 

310 

ties, 

357 

Obliquus  Externus 

mus- 

Muscles  of  the  Neck, 

78 

cle, 

177 

Muscles  of  Thorax, 
Muscles  of  Upper  Extre- 

151 

Obliquus  Internus 
cle, 

Obturator  artery, 

mus- 

179 

mities, 

315 

291 

Musculi  Pectinati, 

159 

Obturator  Externus 

mus- 

Multifidus  Spinre  muscle, 

309 

cle, 

3G5 

Mylo-Hyoideus, 

86 

Obturator  Internus 

mus- 

cle, 

365 

Nasal  Nerve, 

139 

Obturator  Ligament, 

410 

Nails, 

430 

Occipito  Dentate 

Lfga- 

Nervus  Axillaris  orCircum- 

ment, 

407 

flexus, 

350 

Occipito  Frontalis, 

70 

Nerves  of  basis  of  Brain, 
Nervus  Cutaneus  Interims, 

59 

Oesophagus, 

144 

350 

Qdsophageal  arteries, 

286 

Nervus  Musculo-Cutaneus, 

350 

Olfactory  nerves, 

138,60 

Nerves  of  Head  and  Neck, 

103 

Omenta, 

202 

Nervus  Ischiadicus, 

Nerves  of  Lower  Extre- 

c97 

Omentum  Colicum, 

205 

Omentum  majus, 

200,202 

mities, 

392 

Omentum  minus. 

202 

Nervus  Medianus, 

352 

Omentum  Gastro-Spleni- 

Nervus  Motor  Oculi, 

61 

cum, 

205 

Nervus  Obturatorius, 

395 

Omo-Hyoideus, 

85 

Nerve  Olfactory, 

60 

Ophthalmic  artery, 

125 

Nerve  Optic, 

60 

Opponens  Pollicis, 

333 

440 


INDEX. 


PAGE  | 

Optic  nerve,  125,60 

Orbicularis  Oris, 

76 

Orbicularis  Palpebrarum, 

71 

Orifice  of  Parotid  Gland, 

92 

Os  Hyoides, 

145 

Os  Orbiculare, 

130 

Os  Tincae, 

269 

Ostium  Venosum, 

160 

Ovaries, 

269 

Ovula  Nabothi, 

269 

Palatine  Nerve, 

107 

Palmaris  Brevis  muscle, 

332 

Palmaris  Longus, 

321 

Palmaris  Profunda  artery, 

343 

Palato-Pharyngeus  mus- 
cle, 

142 

Palpebral  Ligaments, 

114 

Pancreas,  200,222 

Pancreatic  arteries, 

223 

Papillae, 

140 

“ Capitatae  or  Maxi- 
mas, 

140 

“•  Mediae, 

140 

“ Villosae, 

140 

“ Filiformes, 

140 

Papilla;  of  Kidney, 

224 

Par  Vagum,  276,111,62 

Parotid  Gland, 

91 

Parts  concerned  in  Femoral 
Hernia, 

192 

Pectineus  muscle, 

360 

Pectineal  Fascia, 

194 

Pectoralis  Major  muscle, 

151 

PectoraHs  Minor  muscle, 

152 

Penis, 

240 

Pericardium, 

157 

Perforating  arteries. 

384 

Perineum, 

249 

Perineal  artery, 

293 

Peritoneum, 

201 

Peroneus  Brevis, 

370 

Peroneus  Longus, 

370 

Peroneus  Tertius, 

368 

Peroneal  Artery, 

388 

Peroneal  Nerve, 
Peroneo-TibiaL  Articula- 
tion, 

399 

423 

Pharyngeal  Nerve, 

110 

Pharynx, 

143 

PAGE 


Phrenic  arteries,  287 

Phrenic  Nerve,  113,275 

Pia  Mater,  46 

Pigmentum  Nigrum,  121 

Pineal  Gland,  54 

Pinna,  126 

Pituitary  Gland, 

Plantaris  muscle,  372 

Platysma  Myodes, 

Pleura,  155 

Pleura  Costalis,  155 

Pleura  Pulmonalis,  155 

Plexus  Choroides,  52 

Plexus  Lumbalis,  392 

Pneumogastric  nerve,  111 

Pomum  Adami,  146 

Pons  Varolii,  57 

Posterior  Annularis,  337 

Posterior  Auris,  98 

Posterior  Carpal  Ligament,  331 
Posterior  Chamber  of  Eye,  124 
Portio  Dura,  105 

Posterior  Indicis,  336 

Posterior  Ligaments  of  Ute- 
rus, 266 

Posterior  Mediastinum,  155 

Posterior  Medii,  337 

Posterior  Tibial  artery,  388 

Posterior  Sacro-Sciatic  Li- 
gament, 409 

Posterior  Vertebral  Liga- 
ment, 406 

Popliteal  artery,  385 

Popliteus  muscle,  372 

Popliteal  nerve,  400 

Portio  Dura,  135,62 

Portio  Mollis,  135.62 

Preputium,  240 

Primitive  Iliacs,  290- 

Prior  Annularis,  336 

Prior  Indicis,  336 

Prior  Medii,  337 

Processus  Brevis  of  Incus.  130 
Processus  Brevis  of  Mal- 
leus, 130 

Processus  Gracilis  of  Mal- 
leus, 130 

Processus  Longus  of  In- 
cus, 1 30 

Profunda  artery, 


INDEX. 


441 


Profunda  Humeri  artery', 
Profunda  Minor  artery, 
Promontory  of  Ear, 
Pronator  Quadratus  mus- 
cle, 

Pronator  Radii  Teres  mus- 
cle, 

Prostate  Gland, 

Psoas  Magnus  muscle, 
Psras  Parvus  muscle, 
Pterygoideus  Externus, 
Pterygoideus  Interims, 
Pterygoid  Nerve, 
Pulmonary  Artery, 
Punctual  Lachrymale, 
Pyloric  Orifice  of  Stomach, 
Pupil, 

Pyramid, 

Pyramidalis, 

Pyriformis  muscle, 

Quadratus  Femoris, 
Quadratus  Lumborum, 

Radial  artery, 

Radialis  Indicis  artery, 
Radiated  Ligaments, 
Receptaculum  Chyli, 
Rectum, 

Recurrens  Radialis  artery, 
Recurrent  Tibial  artery, 
Rectus  Abdominis  muscle, 
Rectus  Capitis  Anticus- 
Major, 

Rectus  Capitis  Antieus  Mi- 
nor, 

Rectus  Capitis  Lateralis, 
Rectus  Capitis  Posticus 
major  muscle, 

Rectus  Capitis  Posticus 
minor  muscle, 

Rectus  Femoris  muscle, 
Recurrens  Ulnaris  artery, 
Regio  Pubis, 

Renal  Capsules, 

Renal  Plexus, 

Rete  Mucosum, 

Retina, 

Retraliens  Auriculae  mus- 
cle, 


PAGE 


Rhomboid  Ligament,  414 

Rbomboideus  major  mus- 
cle, 303 

Rbomboideus  minor  mus- 
cle, 303 

Right  Auricle,  159 

Right  Gastro-Epiploic  ar- 
tery, 287 

Right  Hypochondriac  re- 
gion, 173 

Right  Iliac  region,  173 

Right  Lumbar  region,  173 

Right  Ventricle,  160 

Rima  Glottidis,  150 

Root  of  Lung,  165 

Round  Ligaments  of  Blad- 
der, 235 

Round  Ligaments  of  Liver,  212 

Sacculus  Sphericus,  134 

Sacro-Lumbalis  muscle,  806 

Sacro-lliac  Ligament,  409 

Saphena  Magna,  390 

Saphena  Minor,  390 

Saphena  Vein,  194 

Sartorial  Fascia,  194 

Sartorius  muscle,  357 

Scala  Tympani,  134 

Scala  Vestibuli,  134 

Scaleni  Muscles,  89 

Scapha,  127 

Scapularis,  340 

Scapulo-Clavieular  Liga- 
ments, 415 

Schneiderian  Membrane,  137 

Sciatic  Plexus,  396 

Scrobiculus  Cordis,  173 

Scrotum,  244 

Sebaceous  Glands,  431 

Sebaceous  Organs,  430 

Semicircular  Canals,  132 

Semilunar  Valves,  161 

Semilunar  Cartilages,  422 

Semimembranosus,  367 

Semispinalis  Dorsi  mus- 
cle, 309 

Semispinalis  Colli  mus- 
cle, 308 

Semitendinous  muscle,  366 

I Septum  Lucidum,  52 


PAGE 

341 

341 

lt.9 

S26 

320 

237 

230 

230 

78 

78 

107 

162 

114 

207 

122 

129 

182 

363 

860 

231 

342 

343 

41 1 

296 

232 

342 

387 

181 

88 

88 

89 

309 

310 

358 

344 

173 

226 

282 

428 

122 

128 


442 


INDEX. 


PAGE 

Septum  Pectiniforme,  241 

Serratus  major  anticus  mus- 
cle, 152 

Serratus  Superior  Posticus,  £03 
Serratus  Inferior  Posticus 
muscle,  303 

Shoulder  Joint,  416 

Skin,  427 

Sinuses  of  Dura  Mater,  43 
Sinuses  Pulmonalis,  162 

Sinus  of  Ridley,  46 

Sinus  of  Valsalva,  162 

Sinus  Venosus,  159 

Small  Muscles  of  Hand,  332 
Small  Intestines,  208 

Solar  Plexus,  281 

Soleus  muscle,  £71 

Spermatic  arteries,  289,243 
Spermaticus  externus  nerve,  394 
Spheno-Palatine  ganglion,  139 
Spheno-Palatine  nerve,  139 
Sphincter  Ani  muscle,  233,251 
Sphincter  Vaginae  muscle,  265 
Spinal  Accessory  Nerve,  62 
Spinal  Marrow,  65 

Spinalis  Dorsi  muscle,  307 
Splanchnic  nerves,  281 

Spleen,  220,199 

Splenic  artery,  287 

Splenius  Capitis  muscle,  304 
Splenius  Colli  muscle,  304 
Splenius  muscle,  304 

Stapedius,  132 

Stapes,  130 

Stomach,  206,199 

Sterno-Cleido  Mastoideus,  81 
Sterno-Hyoideus,  84 

Sterno-Thyroideus,  85 

Stylo-Glossus  muscle,  86 

Stylo-Hyoideus,  86 

Stylo-Maxillary  ligament,  83 
Stylo-Pharyngeus,  86 

Subclavius  muscle,  152 

Subclavian  artery,  285 

Submaxillary  Gland,  92 

Sublingual  Gland,  141,93 

Subscapularis  muscle,  316 
Sub  Pubic  Ligament,  411 

Sulcus  Transversalis,  213 


PAGE 


Sulcus  Umbilicalis,  213 

Superficialis  Dorsi  Penis,  293 

Superficialis  Volae  artery,  342 

Supra  Spinatus  muscle,  315 

Superior  Maxillary  nerve,  105 

Superior  Mediastinum,  155 

Superior  Mesenteric  artery,  287 

Superior  hemorrhoidal  ar- 
tery, 290 

Superior  Intercostal  artery,  28G 

Superior  Pubic  Ligament,  184 

Supinator  Radii  Brevis,  327,330 
Supinator  Radii  Longus,  327 

Sympathetic,  277,112,280 

Tarsal  artery,  388 

Tarsi  Cartilages,  114 

Temporalis,  77 

Tendo-Achillis,  372 

Tensor  Palati  muscle,  142 

Tensor  Tarsi,  117 

Tensor  Tympani  muscle,  132 

Tensor  Vaginae  Femoris,  357 

Tentorium,  43 

Testes,  244 

Teres  Major  muscle,  316 

Teres  Minor  muscle,  316 

Thigh,  Artery  of  382 

Tibialis  Anticus,  367 

Tibialis  Posticus,  375 

Tongue,  139 

Torcular-Herophili,  45 

Trachea,  166 

Traehelo-Mastoideus  mus- 
cle, 30S 

Tragicus  muscle,  128 

Tragus,  127 

Transversalis  Abdominis,  180 

Transversalis  Cervicis  mus- 
cle, 307 

Transversus  Aura;  muscle,  128 

Transversalis  l inguae,  110 

Transversalis  Pedis  mus- 
cle, 380 

Trapezoid  Ligament,  415 

Trapezius  muscle,  299 

Triangular  Ligament,  415 

Triangular  Ligament  of 
Urethra,  253 


INDEX. 


443 


PAGE 

Triangularis  Sterni  mus- 


cle, 154 

Triceps  Abductor  Femo- 
ris,  360 

Triceps  Extensor  Cubiti,  319 

Triceps  Surse,  371 

Thalamus  Nervi  Optici,  51 

Third  pair  or  Motor  Oculi,  61 

Third  Ventricle,  53 

Thoracic  Duct,  296 

Thoracica  Acromialis,  339 

Thoracica  Axillaris,  340 

Thoracica  Longa,  339 

Thoracica  Superior,  339 

Thorax,  151 

Thyreo-Arytenoideus,  149 

Thvreo-Epiglottideus  mus- 
cle 149 

Thyreo-Hyoideus,  148,85 

Thyroid  Cartilages,  146 

Thyroid  Gland,  90 

Thyroidea  Superior,  95 

Thyroidal  Veins,  103 

Thymus  Gland,  169 

Tonsil  Gland,  142 

Transverse  Ligament,  412 

Trans  versus  Perinei  mus- 
cle, 250 

Tricuspid  Valve,  161 

Trigeminus,  61 

Trochlearis  nerve,  61 

Trunk,  151 

Tuberculum  Loweri,  159 

Tubereula  Quadrigemina,  54 

Tubuli  Seminiferi,  247 

Tubuli  Uriniferi,  224 

Tunica  Albuginea,  246 

Tunica  Arachnoidea,  46 

Tunica  Choroidea,  121 

Tunica  Conjunctiva,  115 

Tunica  Hyaloidea,  123 

Tunica  Sclerotica.  120 

Tunica  Vaginalis  Commu- 
nis, 187 

Tunica  Vaginalis  Testis,  245 

Tympanum,  129 

Ulnar  Artery,  343 


PAGE 


Umbilical  region,  173 

tipper  Extremities,  313 

Urachus,  235 

Ureters,  225 

Uterine  Arteries,  291 

Uterus  and  Appendages,  266 

Uvula,  141 

Vagina,  264 

Vaginal  Ligaments  of  fin- 
gers, 225 

Valve  of  Brain,  55 

Valve  of  Thebesius,  160 

Valve  of  Vieussens,  55 

Valvulag  Conniventes,  209 

Vasa  Brevia,  208 

Vasa  Efferentia,  247 

Vasa  Vorticosa,  121 

Vas  Deferens,  247 

Vastus  Externus  muscle,  358 

Vastus  Internus  muscle,  359 

Vena  Cava  Descendens,  294 

Veins  of  Lower  Extremi- 
ties, 390 

Veins  of  Trunk,  294 

Veins  of  Upper  Extremi- 
ties, 346 

Vena  Axillaris,  347 

Vena  Azygos,  295 

Vena  Basilica,  346 

Vena  Cava  Ascendens,  295 

Vena  Cephalica,  346 

Vena  Galeni,  45 

Vena  Mediana,  345,347 

Vena  Portarum,  214 

Vena;  Satellites  or  Co- 
mites, 347 

Velum  Pendulum  Palati,  141 

Ventricles  and  Convolu- 
tions, 50 

Ventricle  of  Galen  or  Mor- 
gagni, 150 

Verticales  Lingua;,  140 

Vessels  of  Orbit,  124 

Vesiculse  Seminales,  238 

Y7esical  arteries,  291 

Vestibule,  133 

Vestibulum,  263 


444 

INDEX. 

PAGE 

PAGE 

vim. 

210 

Zona  Coriacea, 

133 

Viscera  of  Thorax, 

151 

Zona  Membranacea, 

i:t3 

Vitreous  Humour, 

123 

Zona  Ossea, 

133 

Vulva, 

261 

Zona  Vesicularis, 

i:^3 

Zygomatic  us  major. 

74 

Yellow  Ligaments, 

407 

Zygomaticus  minor, 

75 

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PHILADELPHIA. 


THE  LIBRARY  OF  STANDARD  LITERATURE. 

Under  this  title  L.  & B.  are  publishing  a number  of  valuable  works,  which  should  find  a place 
1 every  library.  Some  of  them  have  been  long  out  of  print,  and  are  no  longer  accessible ; while 
thers  have  been  but  recently  issued,  and  are  now  published  here  for  the  first  time.  They  are  printed 
dth  clear  and  readable  type,  on  good  white  paper,  and  are  sold  at  a price  to  put  them  within 
le  reach  of  all. 

Among  them  will  be  found  the  following  valuable  works ; to  which  others  will,  from  time  to  time, 
e added* 

nie¥uh¥;?^rome. 

'he  History  of  Rome,  by  B.  G.  Niebuhr ; complete  in  two  large  octavo  volumes, 
done  up  in  extra  cloth ; or  five  parts,  paper,  price  Si. 00  each, 
i The  last  three  parts  of  this  valuable  book  have  never  before  been  published  in  this  country,  hav- 
I ig  only  lately  been  printed  in  Germany,  and  translated  in  England.  The  two  last  of  these  com- 
| rise  Professor  Niebuhr’s  Lectures  on  the  latter  part  of  Roman  History,  so  long  lost  to  the  world. 

| “ It  is  an  unexpected  surprise  and  pleasure  to  the  admirers  of  Niebuhr— that  is,  to  all  earnest 
1 udents  of  ancient  history — to  recover,  as  from  the  grave,  the  lectures  before  us.” — Eclectic  Review. 

, ‘‘The  world  has  now  in  Niebuhr  an  imperishable  model.” — Edinburgh  Review , Jan.  1844. 

MILLS’  CRUSADES. 

'he  History  of  the  Crusades,  for  the  Recovery  and  Possession  of  the  Holy  Land, 
by  Charles  Mills.  In  one  part,  paper,  price  $1.00. 

MILLS’  CHIVALRY. 

he  History  of  Chivalry  ; or,  Knighthood  and  its  Times,  by  Charles  Mills. 
In  one  part,  paper,  price  $1.00. 

Also,  the  two  works,  Crusades  and  Chivalry,  in  one  volume,  extra  cloth. 

WAL  P 0L¥^?lfEwT¥T  T E R S. 

he  Letters  of  Horace  Walpole,  Earl  of  Orford,  to  Sir  Horace  Mann,  from 
1760  to  1785.  Now  first  published  from  the  original  MSS.  In  four  parts,  ‘ 
paper,  price  $1.00  each  ; or  two  handsome  volumes,  extra  cloth. 

In  these  volumes,  the  anecdotes  and  comments  on  the  characters  of  the  day  are  of  so  unreserved 
nature,  that  Walpole  took  measures  to  prevent  their  appearance  for  a number  of  years,  until  the 
it  of  the  dead  should  no  longer  wound  the  feelings  of  the  living. 


WRAXALL’S  HISTORICAL  MEMOIRS. 

istorical  Memoirs  of  my  own  Times,  by  Sir  N.  W.  Wraxall.  In  two  parts, 
paper,  or  one  neat  volume,  extra  cloth. 

This  is  the  work  for  which,  in  consequence  of  too  truthful  a portraiture  of  Catherine  II,  the  author 
as  imprisoned  and  fined.  Taught  by  this  experience,  his  succeeding  memoirs  he  suppressed  until 
ter  his  death. 

WRAXALL’S  POSTHUMOUS  MEMOIRS. 

osthumous  Memoirs  of  his  own  Times,  by  Sir  N.  W.  Wraxall.  In  two  parts, 
paper,  at  seventy-five  cents  each  ; or  one  volume,  extra  cloth. 

This  work  contains  much  secret  and  amusing  anecdote  of  the  prominent  personages  of  the  day, 
hich  rendered  its  posthumous  publication  necessary. 


STANDARD  LIBRARY  CONTINUED. 


PROFESSOR  RANKE’S  HISTORICAL  WORKS. 
RANKE’S  POPES. 

History  of  the  Popes,  their  Church  and  State,  during  the  Sixteenth  and  Seven- 
teenth  Centuries,  by  Leopold  Ranke.  Translated  from  the  last  edition  of  the 
German,  by  Walter  K.  Kelly,  Esq.  In  two  parts,  paper,  at  $1.00  each;  or  one 
large  volume,  extra  cloth. 

This  edition  has  translations  of  all  the  Notes  and  Appendices. 


RANKE’S  TURKISH  AND  SPANISH  EMPIRES. 

The  Turkish  and  Spanish  Empires,  in  the  Sixteenth  Century,  and  beginning 
of  the  Seventeenth,  by  Leopold  Ranke.  Translated  from  the  last  edition  of  the 
German,  by  Walter  K.  Kelly,  Esq.  Complete  in  one  part,  paper  ; price  75  cents. 

‘‘Sovereigns  and  Nations  of  Southern  Europe,  in  the  Sixteenth  and  Seventeenth  Centime,," 
is  the  title  common  to  Ranke’s  four  volumes,  of  which  only  the  three  last  constitute  the  well-known 
44  History  of  the  Popes.”  The  first  is  here  produced  as  a separate  work,  with  two  title®,  that  a 
may  be  either  bound  up  with  the  other,  or  used  separately. 

R A N kIFTTeToRMA  T 1 0 N . 

History  of  the  Reformation  in  Germany ; by  Professor  Leopold  Ranke.  Part* 
First  and  Second,  now  ready,  price  25  cents  each.  Translated  from  the  second 
edition,  by  Sarah  Austin.  To  be  completed  in  about  five  parts,  each  part  con- 
taining one  volume  of  the  London  edition. 

This  will  conclude  the  valuable  series  of  Professor  Ranke’s  Historical  works. 

B R 0 W N ING7sHhUGU  E N 0 T S . 

A History  of  the  Huguenots,  a new  edition,  continued  to  the  present  time,  by 
W.  £>.  Browning. 

The  object  of  thin  work  is  to  give  a clear  detail  of  the  troubles  generally  called  the  Religins 
Wars  of  France,  presenting  the  whole  connectedly,  and  divested  of  all  theological  discussion. 

WALPOLE’S  GEORGE  THE  THIRD. 

Memoirs  of  the  Reign  of  King  George  the  Third,  by  Horace  Walpole.  Now 
first  published  from  the  original  MS.  Edited,  with  Notes,  by  Sir  Denis  Le 
Marchant. 

These  Memoira  comprise  the  first  twelve  years  of  the  reign  of  George  III. ; and  recommend 
themselves  especially  to  the  reader  in  this  country,  ns  containing  an  account  of  the  early  trouble^ 
with  America.  They  form  a sequel  to  the  " Memoirs  of  George  the  Second,”  by  the  same  author 

L.  & B.  have  still  on  hand  a few  copies  of  Walpole’s  Early  Letters,  in  four  large  octavo  volumes, 
including  his  ‘‘Memoirs  of  George  II.;”  also,  copies  of  his  suppressed  Letters  to  Sir  Horae® 
Mann,  in  two  octavo  volumes,  completing  the  series  of  his  Historical  Works. 


THE  GREAT  NATIONAL  WORK  AT  TWO  DOLLARS  A VOLUME,  IN  CLOTH. 

LEA  & BLANCHARD  ARE  NOW  ISSUING 

CAPTAIN  WILKES’  NARRATIVE  OF  THE 

UNITED  STATES  EXPLORING  EXPEDITION, 

IN  FIVE  OCTAVO  VOLUMES. 

Containing  nearly  Three  Hundred  Wood-cuts,  Eleven  Maps,  and  nearly 
Twenty-six  Hundred  Pages  of  Letter-press. 

The  text  and  type  of  this  Edition  are  precisely  the  same  as  that  in  imperial  octavo,  the  difiereoM 
consisting  in  the  size  and  qualitv  of  the  paper ; the  omission  of  the  sixty-four  steel  plates  ; me  sub- 
stitution of  wood-cuts  for  the  forty-seven  vignettes ; and  the  use  of  eleven  of  the  fourteen  map®, 
four  of  which  ore  on  a reduced  scale.  The  whole  work  will  be  in  five  octavo  volumes,  elegantly 
done  up  in  cloth,  for  the  very  low  price  of  Ten  Dollars. 


THE  EXPLORING  EXPEDITION 


LEA  AND  BLANCHARD, 

PHILADELPHIA: 

HAVE  JUST  PUBLISHED, 

THE  NARRATIVE  OF  THE 

UNITED  STATES 

EXPLORING  EXPEDITION, 

DURING  THE  YEARS 

1838,  1839,  1840,  1841,  and  1842. 

BY  CHARLES  WILKES,  U.S.N. 

COMMANDER  OF  THE  EXPEDITION,  ETC.  ETC. 

IN  LIVE  MAGNIFICENT  LARGE  IMPERIAL  OCTAVO  VOLUMES; 

WITH  AN  ATLAS  OF  LARGE  AND  EXTENDED  MAPS. 

Price  Twenty-five  Dollars  to  Subscribers,  done  up  in 
beautiful  Extra  Cloth  Binding. 

This  truly  great  and  national  work  is  issued  in  a style  of  superior  magnificence 
and  beauty,  containing 

SEXTY-FOTJR.  LARGE  AND  FINISHED  LINE  ENGRAVINGS, 

EMBRACING  SCENERY,  PORTRAITS,  MANNERS,  CUSTOMS,  ETC.  ETC. 

FORTV-SEVEN  EXQUISITE  STEEL  VIGNETTES, 

WORKED  AMONG  THE  LETTER-PRESS  ; ABOUT 

TWO  HUNDRED  AND  FIFTY  FINELY-EXECUTED  WOOD-CUT  ILLUSTRATIONS 

FOURTEEN  LARGE  AND  SMALL  MAPS  AND  CHARTS; 

AND  NEARLY 

TWENTY-SIX  HUNDRED  PAGES  OF  LETTER-TRESS. 

No  pains  or  expense  have  been  spared  to  render  these  volumes  worthy  of  the  theme  they  illua 
Irate,  and  to  make  them  equal,  if  not  superior,  to  anything  of  the  kind  ever  produced  in  any 
country.  The  whole  work  may  be  regarded  as  a truly  national  one.  Nothing  has  been  used  in 
its  preparation  that  is  not  STRICTLY  AMERICAN,  and  the  design  of  the  Author  and  Pub- 
lishers has  been  to  produce  a book  worthy  of  the  country. 

A specimen  of  the  Plates,  Cuts,  and  general  execution  of  the  work  can  be  seen,  and  the  names 
of  the  persons  wanting  copies  may  be  left  with  the  Publishers,  or  any  of  the  principal  Book- 
sellers throughout  the  Union. 

***  The  publishers  have  for  sale  for  Sixty  Dollars,  in  cloth,  a few  copies  of  the  edition  in  la t&r 
Quarto,  printed  for  distribution  by  the  order  of  Congress.  Only  one  hundred  and  twenty  fiv«* 
of  the  two  hundred  and  fifty  printed  have  been  offered  to  the  public. 


PUBLISHED  BY  LEA  AND  BLANCHARD. 

SIBORNE’S  WATERLOO  CAMPAIGNS; 

WITH  MAPS  AND  PLANS. 

History  of  tlie  War  in  France  and  Belgium  in  1815;  containing  minute  details  of  th< 
Battles  of  Quatre-Bras,  Ligny,  Wavre,  and  Waterloo.  By  Captain  W.  Siborne.  Ii 
one  octavo  volume,  with  Maps  and  Plans  of  Battles,  &c.,  viz: 

1.  Part  of  Belgium,  indicating  the  distribution  of  the  armies  on  commencing  hostilities. 

2.  Field  of  Quatre-Bras,  at  3 o’clock,  P.  M. 

3.  Field  of  Quatre-Bras,  at  7 o’clock,  P.  M. 

4.  Field  of  Ligny,  at  a quarter  past  2 o’clock,  P.  M. 

5.  Field  of  Ligny,  at  half  past  8 o’clock,  P.  M. 

6.  Field  of  Waterloo,  at  a quarter  past  II  o’clock,  A.  M. 

n.  Field  of  Waterloo,  at  a quarter  before  8 o’clock,  P.  M. 

8.  Field  of  Waterloo,  at  5 minutes  past  8 o’clock,  P.  M 

9.  Field  of  Wavre,  at  4 o’clock,  P.  M.,  38th  June. 

30.  Field  of  Wavre,  at  4 o’clock,  A.  M.,  19th  June. 

11.  Part  of  France,  on  which  is  shown  the  advance  of  the  Allied  Armies  into  the  Kingdom. 

" This  officer’s  acquirements  in  a scientific  branch  of  his  profession,  of  which  he  has  given  eri 
dence  in  his  models  of  the  ground  of  Waterloo,  entitle  his  views  of  that  conflict  to  much  highe 
consideration  than  those  of  Mr.  Allison.  With  great  respect  for  his  zeal  and  honesty,  and  admit 
ting  that  professional  knowledge  has  saved  him  from  the  presumptuous  blunders  which  diafiptn 
Mr.  Allison’s  chapters  on  Waterloo.” — Quarterly  Review  for  June , 1845. 


RUSH’S  COURT  OF  LONDON. 

Memoranda  of  a Residence  at  the  Court  of  London,  comprising  Incidents  Official  an< 
Personal,  from  1819  to  1825;  including  Negotiations  on  the  Oregon  Question,  and  otbe: 
Unsettled  Relations  between  the  United  States  and  Great  Britain  ; by  Richard  Rush 
Envoy  Extraordinary  and  Minister  Plenipotentiary'  from  the  United  States  from  181' 
to  1825.  In  one  large  and  beautiful  octavo  volume,  extra  cloth. 

In  1833,  twelve  years  ago,  the  first  series  of  these  entertaining  and  interesting  memoranda  ap 
peared  ; and  coming  from  such  a source,  were  so  favorably  received  that  we  have  long  wonder* 
at  the  abstinence  which  had  prevented  their  being  more  rapidly  followed  out.  Both  for  their  po 
litical  aud  social  matter,  they  belong  to  a class  of  reading  which  it  is  very  desirable  to  cultivate 
In  the  complexion  of  his  mind  the  author  is  so  moderate  and  just  that  his  international  stateraeoL 
are  worthy  of  perfect  credit ; while  the  position  he  occupied  gave  him  such  opportunities  of  mix 
ing  with  the  best  informed  portions  of  society,  that  his  descriptions  and  anecdotes  of  them  are  of 
a most  agreeable  kind. — London  Literary  Gazette. 

MACKINTOSH’S  PHILOSOPHY. 

Dissertation  on  the  Progress  of  Ethical  Philosophy,  by  Sir  James  Mackintosh  ; with 
a Preface,  by  the  Rev.  William  Whewell,  M.A.  From  the  second  Edinburgh  edition 
in  one  neat  octavo  volume. 


HUMAN  HEALTH  : or  the  Influence  of  Atmosphere  and  Locality,  Change  of  .Ait 
and  Climate  Seasons,  Food,  Clothiug,  Bathing,  Mineral  Springs,  Exercise,  Sleep,  Cor- 
poreal and  Mental  Pursuits,  &c.  &c.,  on  Healthy  Men,  constituting  Elements  of  Hy- 
giene. By  Robley  Dunglison,  M.  D.,  &c.  &c.  In  one  octavo  volume. 

EVERY  MAN  HIS  OWN  FARRIER!  containing  the  Causes,  Symptom? 
and  Methods  of  Cure  of  the  Diseases  of  Horses,  by-Francis  Clater  and  John  Clater. 
From  the  28th  London  edition.  By  J.  S.  Skinner  ; in  one  12mo.  volume. 

THE  DOG  AND  THE  SPORTSMAN:  embracing  the  Uses,  Breeding,  Train 
ing.  Diseases,  Ac.  &c„  of  Dogs.  An  account  of  the  Different  Kinds  of  Game,  with 
their  Habits  ; also.  Hints  to  Shooters,  with  various  useful  Recipes  : by  J.  S.  Skinner. 
In  one  neat  12mo.  volume,  with  Engravings. 

REMARKS  ON  THE  INFLUENCE  OF  MENTAL  EXCITEMENT, 
and  Mental  Cultivation  upon  Health!  by  A.  Brigham,  M.D.  Third  edi- 
tion ; one  volume,  18mo. 

RELIGIO  MEDICI,  AND  ITS  SEQUEL,  CHRISTIAN  MORALS! 

hy  Sir  Thomas  Browne,  Kt.,  with  Resemblant  Passages  from  Cowper's  Task.  In  one 
rwat  12mo.  volume. 


PUBLISHED  BV  LEJ1  Jf  BLJUVCHABD, 


[RBY  & SPENCE’S  ENTOMOLOGY,  FOR  POPULAR  USE. 
AN  INTRODUCTION  TO  ENTOMOLOGY; 

< , ELEMENTS  OF  THE  NATURAL  HISTORY  OF  INSECTS : COMPRISING 
AN  ACCOUNT  OF  NOXIOUS  AND  USEFUL  INSECTS,  OF  THEIR 
METAMORPHOSES,  FOOD,  STRATAGEMS,  HABITA- 
TIONS, SOCIETIES,  MOTIONS,  NOISES,  HYBER- 
NATION, INSTINCT,  &c.,  &c. 

With  Plates,  Plain  or  Colored. 

By  William  Kirby,  M.  A.,  F.  R.  S.  And  William  Spence,  Esq.,  F.R.S. 

From  the  Sixth  London  edition, 

WHICH  WAS  CORRECTED  AND  CONSIDERABLY  ENLARGED. 

In  one  large  octavo  volume,  extra  cloth. 

his  work,  as  it  at  present  stands,  is  acknowledged  to  be  the  best  extant  as  a popular  intro- 
d .ion  to  the  science,  containing  an  immense  amount  of  singular  and  interesting  information, 
c veyed  in  an  agreeable  manner.  In  preparing  the  last  edition,  from  which  this  is  printed, 
iiiuthors  have  omitted  the  two  last  volumes,  as  being  too  scientific  for  popular  use,  and  arranged 
it  it  now  is,  forming  a complete  exposition  of  the  principles  of  the  study,  unincumbered  with 
a .omical  or  scientific  details. 

This  publication  is  one  of  the  highest  character  of  its  class;  and  while  the  information  it 
c.ains  is,  generally  speaking,  valuable  and  instructive,  much  of  it  is  remarkably  curious  and 
ii  resting.  The  work  is  comprised  in  a volume  of  six  hundred  pages,  and  should  have  a place 
every  well-chosen  library.”— Inquirer. 

THE  LANGUAGE  OF  FLOWERS, 

ITH  ILLUSTRATIVE  POETRY;  TO  WHICH  ARE  NOW  ADDED 
’HE  CALENDAR  OF -FLOWERS,  AND  THE  DIAL  OF  FLOWERS. 

SEVENTH  AMERICAN,  FROM  THE  NINTH  LONDON  EDITION. 

Revised  by  the  Editor  of  the  “ Forget-Me-Not.” 

In  one  very  neat  18 mo,  volume , eptra  crimson  cloth , gilt. 

WITH  SIX  COLORED  PLATES. 

M A R S T O N, 

)R  THE  MEMOIRS  OF  A STATESMAN  AND  SOLDIER. 

By  the  REV.  GEORGE  CROLY. 

Author  of  “ Salathiel,”  “ Angel  of  the  World,”  &c. 

IN  ONE  OCTAVO  VOLUME,  PAPER,  PRICE  FIFTY  CENTS. 

A work  of  high  character  and  absorbing  interest.” — N.  O.  Bee. 

THOUGHTS  ON  ANIMALCULES, 

OR  A GLIMPSE  OF  THE  INVISIBLE  WORLD. 

REVEALED  BY  THE  MICROSCOPE. 

By  G.  A.  MANTELL,  LL.D.,  F.R.S.,  &c. 

In  one  beautiful  volume , square  12 mo.  extra  cloth* 

WITH  WOOD-CUTS  AND  COLORED  PLATES. 


EUBLISUEB  BY  LEA  K BLAJS'CBABD. 

GRAHAME’S  UNITED  STATES. 

THE  HISTORY 

OF  THE 

UNITED  STATES  OF  NORTH  AMERICA. 

FROM  THE  PLANTATION  OF  THE  BRITISH  COLONIES  TILL  THEIR  ASSUMPTK 
OF  NATIONAL  INDEPENDENCE. 

BY  JAMES  GRAHAME,  LL.D. 

Second  edition,  enlarged  and  amended.  With  a portrait  of  the  author,  a 
A Memoir  by  PRESIDENT  QUINCY. 

In  four  volumes,  beautifully  printed. 

This  edition  of  Grahame’s  standard  work  is  far  preferable  to  the  English  edition,  as  coni; 
ing  the  author’s  latest  amendments  and  corrections.  From  its  first  appearance  in  1836  to 
death  in  1842,  he  was  occupied  in  revising  it.  All  these  MSS.  were  given  by  his  son  to  I 
vard  College,  and  it  is  from  them  that  this  has  been  printed,  under  the  supervision  of  the  H 
Josiah  Quincy. 

That  this  work  may  have  a circulation  commensurate  with  its  merits,  the  publisher 
preparing  a new  edition  to  form  two  large  octavo  volumes.  Though  reduced  in  size  and  pr 
this  will  contain  the  whole  work,  without  abridgment,  printed  on  fine  while  paper,  and  * 
the  same  type,  though  arranged  to  form  a larger  page.  A few  copies  of  the  four  volume  edit 
on  extra  fine  thick  paper,  still  remain,  and  can  be  had  by  gentlemen  desirous  of  procurit 
beautiful  work  for  their  libraries. 


ROSCOE’S  KINGS  OF  ENGLAND. 

LIVES  OF  THE  KINGS  OF  ENGLAND  FROM  TIIE 

NORMAN  CONQUEST. 

WITH  ANECDOTES  OF  THEIR  COURTS. 

NOW  FIRST  PUBLISHED  FROM  OFFICIAL  RECORDS  AND  OTHER  DOCUMENTS. 

BY  THOMAS  ROSCOE. 

Forming  a neat  duodecimo  series,  to  match  Miss  Strickland’s  “ Queens  of  Englan 
Volume  I.  contains  the  Life  of  “ William  the  Conqueror.” 

“The  ‘Lives  of  the  Kings  of  England,’  must  therefore  prove  a valuable  auxiliary  to tl 
readers,  who,  fond  of  tracing  effects  up  to  their  true  causes,  are  desirous  of  ascertaining  the 
share  contributed  by  each  of  the  British  Sovereigns  to  those  results  which  have  conferred  on 
country  and  nation  their  present  proud  pre-eminence  in  power,  prosperity,  freedom,  andgl 
To  such  as  seek  amusement  only,  they  cannot  fail  to  be  equally  acceptable,  as  a conne 
record  of  the  sayings  and*  doings  of  personages,  many  of  them  ranking  foremost  as  mode 
chivalry,  and  most  enjoying  the  highest  renown  among  the  politicians  and  the  warriors  of  i ' 
own  time.” 


MOORE’S  IRELAND. 

THE  HISTORY  OF  IRELAND, 

FROM  THE  EARLIEST  KINGS  OF  THAT  REALM  DOWN  TO  ITS  LATI ' 

CHIEFS. 

In  two  octavo  volumes,  extra  cloth. 

Mr.  Moore  has  at  length  completed  his  History  of  Ireland  during  the  most  troubled  and  i • 
resting  periods  through  which  it  has  passed.  Those  who  have  possessed  themselves  of  the  v ; 
as  far  as  the  Great  Expedition  against  Scotland  in  1543,  can  procure  the  second  volume  sepa: 


PUBLISHED  BY  LEA  & BLANCHARD, 

INGERSOLL’S  LATE  WAR. 

HISTORICAL  SKETCH 

OF  THE 

SECOND  WAR 

I TWEEN  THE  UNITED  STATES  OF  AMERICA  AND  GREAT  BRI- 
TAIN, DECLARED  BY  ACT  OF  CONGRESS,  JUNE  18,  1812, 

AND  CONCLUDED  BY  PEACE,  FEB.  15,  1815. 

BY  CHARLES  J.  INGERSOLL. 

C:  volume  octavo  of  516  pages,  embracing  the  Events  of  1812 — 1813.  Beautifully 
printed,  and  done  up  in  neat  extra  cloth. 

The  History  of  Mr.  Ingersoll,  we  cannot  doubt,  will  create  no  little  excitement  throughout 
t country.  The  universally  interesting  nature  of  the  subject,  the  vigour  and  ability  with 
v ch  it  is  evidently  written,  and  the  manner  in  which  distinguished  men,  living  and  dead, 
re  connected  with  the  great  events  it  narrates,  will  combine  to  give  it  a very  wide  circula- 
1 1.  It  will  be  in  many  respects  the  most  marked  publication  of  the  day.  We  can  see  marks 

0 vigour  of  mind,  a fulness  of  investigation  and  a striking  originality  of  manner,  which  can- 
7 fail  to  make  the  book  exceedingly  attractive  to  a very  wide  circle  of  readers.”— A.  Y. 

! trier  and  Enquirer. 

We  do  not  remember  ever  to  have  read  a more  striking  sketch  than  the  one  just  preceding. 

1 i of  a character  with  the  whole  book,  and  imparts  to  the  style  of  the  writer  a degree  of  un- 
iat spirit,  making  it  more  like  some  well-told  and  ingenious  story,  than  the  detail  of  mere 
t.ters  of  fact.  We  have  no  doubt  that  Mr.  Ingersoll’s  book  willbe  rapidly  purchased  and 
t erly  read.  Men  of  all  parties  will  admire  its  frankness,  and  the  numerous  rich  and  long- 
tied  stores  of  information  with  which  it  abounds.  Even  those  who  would  assail,  will  pause 
lore  views  so  ably,  so  boldly,  and  so  intelligently  expressed,  and  portraits  so  critical  and 
j .” — Daily  Union. 

FRENCH~COOKERY. 

In  One  Large  Octavo  Volume,  with  many  Cuts. 
THE  MODERN  COOK; 

A PRACTICAL  GUIDE  TO  THE  CULINARY  ART  IN  ALL  ITS 
BRANCHES, 

DAPTED  AS  WELL  FOR  THE  LARGEST  ESTABLISHMENTS  AS  FOR 
PRIVATE  FAMILIES.  ' 

BY  CHARLES  ELME  FRANCATELLI, 

Pupil  of  the  celebrated  Careme ; late  Maitre  D’Hotel,  and  Chief  Cook  to  her 
Majesty  the  Queen,  &c. 

IN  ONE  VERY  NEAT  OCTAVO  VOLUME,  WITH  UPWARDS  OF  SIXTY  ILLUSTRATIONS. 

’his  volume  will  take  the  place  formerly  occupied  by  the  elaborate  work  of  Ude.  It  con- 
tis  ample  instructions  for  making  all  the  choicest  French  dishes,  from  the  simplest  to  the 
) 3t  complex. 

CHEMISTRY  OF  THE  FOUR  SEASONS, 

BY  GRIFFITH. 

IN  ONE  VERY  NEAT  DUODECIMO  VOLUME.  WlTH  NUMEROUS  WOOD-CUTS. 

'he  object  of  this  little  book  is  to  show  in  a popular  and  agreeable  manner  the  chemical 
tncy  exerted  in  the  various  phenomena  of  nature.  It  forms  a neat  volume  for  the  Centre 
'ble. 


A TREATISE  ON 

ORNS,  BUNIONS,  THE  DISEASES  OF  THE  NAILS,  AND 
THE  GENERAL  MANAGEMENT  OF  THE  FEET. 

BY  LEWIS  DURLACHER,  Surgeon  Chiropodist  to  the  Queen. 

In  one  duodecimo  volume,  cloth. 


l 


LIVES 

OF  THE 


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NEW  EDITION,  WITH  CORRECTIONS  AND  ADDITIONS. 

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In  old  historic  rolls,  I opened.’ * 

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PUBLISHED  BY 

LEA  AND  BLANCHARD 

PHILADELPHIA: 


PUBLISHED  BY  LEA  AND  BLANCHARD. 


MISS  ACTON’S  COOKERY. 


MODERN  COOKERY  IN  ALL  ITS  BRANCHES,  reduced  to  a 
System  of  Easy  Practice,  for  the  use  of  Private  Families.  In  a Series 
of  Practical  Receipts,  all  of  which  are  given  with  the  most  minute 
exactness.  By  Eliza  Acton.  With  numerous  Wood-cut  Illustrations. 
To  which  is  added,  a Table  of  Weights  and  Measures.  The  whole 
revised  and  prepared  for  American  Housekeepers,  by  Mrs.  Sarah 
J.  Hale,  from  the  second  London  edition.  In  one  large  12mo.  volume. 

The  publishers  beg  to  present  a few  of  the  testimonials  of  the  English 
press  in  favour  of  this  work. 

“ Miss  Eliza  Acton  may  congratulate  herself  on  having  composed  a work  of  great  utility,  and 
one  that  is  speedily  finding  its  way  to  every  ‘dresser’  in  the  kingdom.  Her  Cookery-book  is 
unquestionably  the  most  valuable  compendium  of  the  art  that  has  yet  been  published.  It 
strongly  inculcates  economical  principles,  and  points  out  how  good  things  may  be  concocted 
without  that  reckless  extravagance  which  good  cooks  have  been  wont  to  imagine  the  best  evi- 
dence they  can  give  of  skill  in  their  profession.” — London  Morning  Post . 

" The  arrangement  adopted  by  Miss  Acton  is  excellent.  She  has  trusted  nothing  to  others. 
She  has  proved  all  she  has  written  by  personal  inspection  and  experiment.  The  novel  feature 
of  her  book,  which  will  greatly  facilitate  the  labours  of  the  kitchen,  is  the  summary  appended  to 
each  recipe  of  the  materials  which  it  contains,  with  the  exact  proportion  of  every  ingredient, 
and  the  precise  time  required  to  dress  the  whole.” — London  Jlllas. 

“Aware  of  our  own  incompetency  to  pronounce  upon  the  claims  of  this  volume  to  the  confi- 
dence of  those  most  interested  in  its  contents,  we  submitted  it  to  more  than  one  professor  of  the 
art  of  cookery.  The  report  made  to  ua  i9  more  than  favourable.  We  are  assured  that  Miss 
Acton’s  instructions  may  be  safely  followed ; her  receipts  are  distinguished  for  excellence.  The 
dishes  prepared  according  to  Miss  Acton’s  directions — all  of  which,  she  tells  us,  have  been 
tested  and  approved — will  give  satisfaction  by  their  delicacy,  and  will  be  found  economical  in 
price  as  well  as  delicious  in  flavour.  With  such  attestations  to  its  superior  worth,  there  is  no 
doubt  that  the  volume  will  be  purchased  and  consulted  by  the  domestic  authorities  of  every 
family  in  which  good  cookery,  combined  with  rigid  economy,  is  an  object  of  interest.” — Globe. 

“ We  have  subjected  this  book  to  the  severe  test  of  practice,  and  we  readily  concede  to  it  the 
merit  of  being  a most  useful  auxiliary  to  the  presiding  genius  of  the  cuisine.  The  instructions 
it  gives  in  all  that  relates  to  culinary  affairs  are  comprehensive,  judicious,  and  completely 
divested  of  old-fashioned  twaddle.  It  contains,  besides,  some  novel  features,  calculated  to  facili- 
tate the  labours  of  cookery;  the  principal  of  these  is  the  summary  appended  to  each  receipt  of 
the  exact  quantities  of  the  ingredients  it  contains,  and  the  precise  time  required  to  dress  the 
dish.  To  the  practical  woman  who  seeks  to  combine  comfort  with  economy  in  the  direction  of 
her  household  concerns,  this  book  will  prove  an  invaluable  treasure.” — Sunday  Times. 

“ We  cannot,  therefore,  too  warmly  recommend  to  the  notice  of  our  junior  brethren  this  com- 
pilation of  Eliza  Acton's,  which  will  prove  as  useful  to  young  Mrs.  and  her  cook  in  the  kitchen, 
as  Thomson’s  Dispensatory  or  Conspectus  to  the  young  doctor  in  the  library.” — Medico- Chirur- 
eical  Review. 

“ Mistress  Acton  writes  well,  to  the  point,  and  like  a woman  of  sterling  sense ; her  preface  ought 
to  be  printed  on  a broadside,  and  taught  to  all  the  young  ladies  at  all  the  boarding-schools, 
and  all  the  day-schools,  whether  boarding  or  not,  in  England. 

“The  whole  of  Miss  Acton’s  receipts,  with  a few  trifling  exceptions,  which  are  scrupu- 
lously specified,  4 are  confined  to  such  as  may  be  perfectly  depended  on  from  having  been  proved 
beneath  our  own  roof,  and  under  our  personal  inspection.’  We  add,  moreover,  that  the 
receipts  are  all  reasonable,  and  never  in  any  instance  extravagant.  They  do  not  bid  us  sacri- 
fice ten  pounds  of  excellent  meat  that  we  may  get  a couple  of  quarts  of  gravy  from  it ; nor  do  they 
deal  with  butter  and  eggs  as  if  they  cost  nothing.  Miss  Acton’s  book  is  a good  book  in  every 
way ; there  is  right-mindedness  in  every  page  of  it,  as  well  as  thorough  knowledge  of  the  sub- 
ject she  handles.” — London  Medical  Gazette.  (14) 


NOW  OFFERED  AT  HALF  THE  SUBSCRIPTION  PRICE, 


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ON  THE  BASIS  OF  THE  SEVENTH  EDITION  OF  THE  GERMAN 


CONYERS  ATIONS-LEXICON. 


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PHILADELPHIA: 

LEA  AND  BLANCHARD. 

1843. 

IN  THIRTEEN  VOLUMES.  **©S§§*2|gg| 


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—THE  NATURAL  HISTORY  OF  EACH  COUNTRY ; 

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CIVIL  AND  SOCIAL  STATE  OF  ALL  NATIONS ; 

BY  HUGH  MURRAY  F.R.S.E. 

ASSISTED  IN 

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A MAP  OF  THE  UNITED  STATES, 

Drawn  by  Drayton,  from  Tanner’s  Map,  and  Engraved  on  Copper,  in  which  is  embodied  the 
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REVISED,  CORRECTED, 

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PHILADELPHIA. 


A NEW  WORK  FOR  SCHOOLS. 


WHITE’S  UNIVERSAL  HISTORY. 


LEA  AND  BLANCHARD 


HAVE  LATELY  PUBLISHED, 


EMITS  Of  imVWAL  BISTORT. 


ON  A NEW  AND  SYSTEMATIC  PLAN; 

FROM 


THE  EARLIEST  TIMES  TO  THE  TREATY  OF  VIENNA  ; 

TO  WHICH  IS  ADDED, 

A SUMMARY  OF  THE  LEADING  EVENTS  SINCE  THAT  PERIOD  , 

FOR  THE 

USE  OE  SCHOOLS  AND  PRIVATE  STUDENTS. 

BY  H.  WHITE,  B.A., 

TRINITY  COLLEGE,  CAMBRIDGE  J 

WITH  ADDITIONS  AND  QUESTIONS, 

BY  JOHN  S.  HART,  A.M., 

PRINCIPAL  OF  THE  PHILADELPHIA  HIGH  SCHOOL,  AND  PROFESSOR  OF  MORAL 
AND  MENTAL  SCIENCE,  ETC.,  ETC. 

In  one  Volume,  large  Duodecimo,  neatly  bound  in  Maroon. 


The  Publishers,  in  presenting  “ Whites  Universal  History"  to  the  public, 
believe  that  it  is  calculated  to  fill  a deficiency,  long  existing  in  school-books,  of  a 
good  and  an  accurate  condensed  manual  of  the  History  of  the  World,  fitted  as  an 
essentially  appropriate  work  for  schools.  Some  of  those  now  in  use  have  been 
long  before  the  public,  and  since  their  appearance,  many  interesting  investigations 
have  been  made,  and  important  facts  developed  ; some  are  meagre  in  their  details, 
and  the  narrations  given  are  proved  by  later  researches  to  be  incorrect ; while  none 
embrace  a broad  and  philosophical  view  of  the  gatherings  of  late  historians. 

It  is  believed  that  the  present  volume  is  capable  of  fulfilling  these  indications. 
The  Author,  who  has  had  great  experience  as  a teacher  of  history,  has  spent 
several  years  in  the  composition  of  the  work  ; and  every  effort  has  been  made  to 
insure  its  accuracy  during  its  passage  through  the  press.  In  his  Preface,  he  re- 
marks that  “ he  has  consulted  the  best  works  in  the  English  language,  and 
acknowledges  his  great  obligations  to  several  of  the  more  recent  French  and  Ger- 
man writers.  The  references  introduced  in  the  body  of  the  work,  serve  to  indicate 
the  main  sources  from  which  his  information  has  been  derived  ; and  it  is  hoped 
they  will  also  be  serviceable  to  the  student,  by  directing  the  course  of  his  further 
researches,  as  well  as  inducing  him  to  continue  them  in  a more  extended  field.” 


WHITE’S  UNIVERSAL  HISTORY. 

The  work  is  divided  into  three  parts,  corresponding  with  Ancient,  Middle,  and 
Modern  History;  which  parts  are  again  subdivided  into  centuries,  so  that  the  various 
events  are  presented  in  the  order  of  time,  while  it  is  so  arranged  that  the  annals 
of  each  country  can  be  read  consecutively,  thus  combining  the  advantages  of  both 
the  plans  hitherto  pursued  in  works  of  this  kind.  To  guide  the  researches  of  the 
student,  there  will  be  found  numerous  synoptical  tables,  with  remarks  and  sketches 
of  literature,  antiquities,  and  manners,  at  the  great  chronological  epochs. 

As  to  the  method  to  be  adopted  in  using  this  manual,  “ the  compiler  deems  it 
unnecessary  to  offer  any  lengthened  directions  ; the  experienced  teacher  will  readily 
adopt  that  best  suited  to  those  under  his  charge.  The  work  may  be  used  simply 
as  a reading-book  ; but  a certain  portion  should  be  given  aut  for  the  attentive  study 
of  the  pupil,  after  which  he  should  be  closely  questioned,  not  only  as  to  the  more 
general  facts,  but  also  the  most  trivial  circumstances  recorded.”  To  facilitate  this 
exercise  on  the  part  of  the  teacher,  the  American  Editor,  Mr.  J.  S.  Hart,  has 
added  a series  of  Questions,  which  will  be  found  very  useful  to  those  who  prefer 
this  mode  of  instruction. 

In  preparing  this  edition,  the  American  Editor  has  paid  particular  attention  to 
those  portions  of  the  work  which  treat  of  American  History,  making  them  more 
full,  and  correcting  those  mistakes  which  are  inevitable  in  one  residing  at  such  a 
distance  from  the  source  of  information.  His  extended  and  well-earned  reputation 
as  a teacher,  is  a sufficient  guarantee  that  whatever  has  passed  under  his  revision 
will  be  free  from  all  errors  of  importance. 

In  conclusion,  the  publishers  have  to  observe,  that  during  the  short  time  in  which 
this  work  has  been  before  the  public,  it  has  received  the  most  flattering  testimonids 
of  approbation.  Already  it  has  been  introduced  into  many  of  the  highest  class  of 
institutions  for  instruction,  and  three  editions  have  been  called  for  in  less  than  a year. 

A few  recommendations  and  notices  are  subjoined. 

Messrs.  Lea  (f-  Blanchard: 

Gentlemen — I return  the  volume  of  “Elements  of  Universal  History”  you 
left  with  me  a few  days  since.  On  a cursory  examination,  it  appears  to  me  to  be 
much  the  best  of  the  elementary  works  on  the  subject  which  I have  met  with. 
The  author  has  executed  his  method  with  a great  deal  of  skill,  and  by  this  means 
has  avoided  much  of  the  confusion  which  is  apt  to  occur  in  manuals  of  Universal 
History.  The  book  is  a very  comprehensive  one,  and  must  have  cost  Mr.  White 
great  labor  in  collating,  and  still  more  in  arranging  his  materials.  He  shows,  more- 
over, a direct  acquaintance  with  many  of  the  best  historical  authorities,  among 
them,  those  of  late  years.  I have  turned  to  several  periods  of  history  which  I 
thought  would  be  most  likely  to  show  its  character,  and  find  them  treated  wnh 
considerable  fairness  and  accuracy  ; indeed,  it  is  unusually  free  from  the  prejudices 
that  often  disfigure  books  of  this  sort — I mean  on  questions  of  history. 

The  book  is  one  that  might,  I am  inclined  to  think,  be  introduced  with  advan- 
tage as  an  historical  text-book  for  the  younger  classes  in  our  colleges.  It  will  be 
found,  too,  I believe,  a convenient  manual  for  private  students,  which  is  one  of  the 
uses  contemplated  by  the  author.  Let  me  add  that,  judging  from  the  passages  I 
have  looked  at,  the  book  is  written  in  good,  unaffected  English. 

Truly  and  respectfully, 

HENRY  REED, 

Professor  of  Belles  Lettres  in  the  University  of  Pennsylvania. 


A NEW  WORK  FOR  SCHOOLS. 


Clinton  St.,  Phila.  Sept.  15,  1844. 

Messrs.  Lea  Blanchard  : 

Gentlemen, — I thank,  you  for  the  copy  of  “White’s  Elements  of  Universal  His- 
tory,” which  you  were  so  kind  as  to  send  me.  After  a somewhat  careful  examination 
of  it,  I was  so  much  pleased  with  its  arrangement,  with  the  judgment  evinced  in 
’ it  in  the  selection  of  facts,  and  in  the  high  moral  tone  which  pervades  it  through- 
out, that  I determined  to  introduce  it  into  my  school.  My  first  class  have  been 
studying  it  since  the  commencement  of  the  term,  and  I am  increasingly  pleased 
with  it.  Respectfully  yours,  C.  D.  CLEAVELAND,  A.M. 

Author  of  “Grecian  Antiquities,  ’ <$-c. 


Messrs.  Lea  ij-  Blanchard: 

I am  indebted  to  your  politeness  for  an  opportunity  of  examining  White’s  Ele- 
ments of  Universal  History,  lately  published  by  you.  It  gives  me  pleasure  to  add 
my  suffrage  to  the  respectable  testimonials  of  teachers  and  others,  with  which  the 
work  has  been  favoured. 

In  my  opinion,  it  affords  to  teachers  and  students  a facility  for  imparting  and  ac- 
quiring a knowledge  of  history,  superior  to  any  single  volume  I have  ever  met 
with,  while  it  proves  an  invaluable  addition,  as  a book  of  reference,  to  every  pri- 
vate gentleman’s  library.  JOSEPH  P.  ENGLES, 

Classical  Institute. 

Philadelphia,  August  20th,  1844. 


Messrs.  Lea  <$-  Blanchard: 

Gentlemen — I offer  you  my  sincere  thanks  for  the  copy  of  “White’s  Universal 
History,”  which  you  were  so  kind  as  to  send  me  a few  days  ago.  The  work 
pleases  me  so  much,  that  I have  determined  to  use  it  in  my  academy. 

I am,  very  respectfully, 

Your  obedient  servant, 

CHA’S  PICOT. 


NOTICES  OF 


Tho  Westminster  Review,  in  noticing  the  work, 
remarks — “ Without  branching  out  into  unneces- 
sary or  minute  details,  it  contains  a succinct  nar- 
rative of  the  principal  events  in  our  world’s  his- 
tory, from  the  earliest  ages  to  the  present  time, 
drawn  up  in  a simple  and  luminous  6tyle. 

The  author  makes  no  pretensions  to  originality; 
“If  he  shall  be  pronounced  fortunate  in  the 
choice  and  condensation  of  his  materials,  he 
will,”  he  says,  “have  attained  the  object  of  his 
wishes.”  This  modest  claim  we,  for  our  part, 
unhesitatingly  accord  to  his  labours.  The  present 
summary  will  not  only  prove  a valuable  class- 
book,  but  may  bo  advantageously  consulted  by 
those  who  have  not  in  youth  been  systematically 
trained  in  historical  knowledge.” 


“ The  Elements  of  Universal  History”  is  en- 
titled to  great  praise  ; the  writer  has  taken  firm 
grasp  of  his  subject : he  exhibits  a just  estimate  of 


THE  PRESS'. 

things,  and  separates,  by  typographical  changes, 
the  narrative  of  events  from  the  commentary  on 
them.” — Spectator. 

| “ This  work  has  been  compiled  with  skill.” — 

< JJlhenceum. 

f “ This  work  appears  to  us  to  supply  a want 
> which  has  long  been  felt  in  American  Schools 
and  Colleges.  The  History  of  the  World,  from 

< the  Creation  down  to  the  present  time,  has  been 
arranged  by  Mr.  White  in  such  a way  as  to  reo- 

< der  the  study  of  his  elegant  synopsis  easy  and 
t agreeable.  From  its  character,  we  believe  that 
? this  book  is  ultimately  destined  to  supersede  eve- 
i ry  other  in  the  same  department  that  has  hitherto 
; appeared.  The  style  in  which  it  is  ‘ got  up’ 
\ does  credit  to  the  enterprising  publishers.” — .Yew 
| World. 

< 41  We  were  induced,  by  several  notices  of  this 


WHITE’S  UNIVERSAL  HISTORY. 


book,  to  look  with  more  care  into  it  than  we  have 
usually  time  to  bestow  on  works  of  this  class.  It 
is  a British  production,  but  the  author  is  quite  as 
free  from  prejudice  as  one  could  possibly  expect. 
The  plan  is  very  judicious.  It  compresses  into 
one  volume  a survey  of  universal  history, — a 
complete  blank  form  which  the  student  can  com- 
prehend at  a glance,  and  fill  up  at  his  leisure. 
For  schools  it  is  particularly  well  adapted,  as  the 
questions  upon  the  text,  appended  by  Mr.  Hart, 
facilitate  the  use  of  it  for  the  teacher  and  increase 
its  value  for  the  learner.” — North  American. 

“A  work  which  gives,  in  a succinct  narration, 
the  principal  events  in  the  history  of  the  world,  if 
faithfully  executed,  cannot  fail  to  be  of  vast  im- 
portance to  private  students  as  well  as  for  the  use 
of  schools.  The  volume  here  given  to  the  pub- 
lic, has  evidently  been  prepared  with  much  care. 
It  is  arranged  with  great  convenience,  and  the 
narratives  of  events  are  given  in  a style  that 
will  doubtless  prove  interesting  to  every  reader. 
We  think  it  one  of  the  best  manuals  of  Universal 
I History  that  has  ever  been  published.” — Satur- 
day Courier. 

“ On  the  whole,  this  mu9t  be  regarded  as  one 
of  the  most  compendious  and  well  arranged 
works  that  have  appeared  ; and  if  used  for  no 
other  purpose  than  as  a chronological  guide,  will 
prove  most  valuable.” — Saturday  Post. 

44  The  great  merit  is  in  the  arrangement  of  the 
matter,  which  is  admirable,  and  will  be  found  to 
assist,  in  an  eminent  degree,  the  teacher  and  the 
reader. 

44  Mr.  Hart  has  well  executed  his  share  of  the 
work,  and  given  thereto  an  important  ingredient 
in  its  usefulness.” — U.  S.  Gazette. 

44  It  is  on  a new  ard  excellent  systematic  plan, 


containing  a brief  narrative  of  the  principal 
events  in  the  history  of  the  world,  from  the  ear- 
liest ages  to  the  present  time.  An  important 
feature  in  the  work,  is  its  arrangement  into  pe- 
riods of  centuries.  This  is  decidedly  of  very 
great  advantage  to  the  student,  and  cannot  fail  to 
commend  the  work.” — Boston  Atlas. 

4‘  The  work  is  a brief  narrative  of  the  principal 
and  most  interesting  events  in  the  history  of  the 
world,  but  these  events  are  placed  in  such  a 
shape  as  to  enable  the  mind  of  the  student  or 
reader  to  grasp  them  with  more  certainty  and 
less  difficulty  of  retention  than  by  the  old-fashion 
ed  method. — This  must  surely  operate  as  a pow 
erful  recommendation  in  favour  of  its  usefulness 
to  the  casual  reader,  as  well  as  to  the  student — 
we  allude  particularly  to  its  chronological  ar- 
rangement, and  general  memoranda  of  events, 
comprised  within  the  limits  of  the  last  century — 
the  genealogical  tables  with  which  it  abounds, 
and  the  conciseness,  yet  clearness  of  its  notes. 
The  author  is  indebted  to  the  most  scientific  of 
modern  travellers,  (in  whom  only  he  seems  to 
place  confidence)  for  the  valuable  information  he 
gives  in  his  notes,  which,  in  addition  to  the  facts 
they  narrate  and  explain,  display  an  admirable 
perspicuity  of  language  that  must  gratify  the 
reader,  and  tend  to  increase  his  interest  as  he 
progresses.” — N.  Orleans  Age. 

44  Under  whatever  circumstances  persons  are 
led  to  seek  an  acquaintance  with  general  history, 
the  work  by  Mr.  While  will  serve  to  gratify  their 
longings  in  this  particular,  and  to  aid  them  in 
treasuring  up  a vast  amount  of  well  arranged 
and  clearly  told  historical  incidents,  of  the  dif- 
ferent people  who  have  flourished,  in  successive 
ages,  from  the  earliest  date  down  to  the  present 
time. — Colonization  Herald. 


STATE  OF  NEW  YORK: 

Secretary's  Office,  ? 

Department  of  Common  Schools,  5 Albany,  October  14,  1845. 


Messrs.  Lea  and  Blanchard  : 

Gentlemen, — I have  examined  the  copy  of  “White’s  Universal  History,” 
which  you  were  so  obliging  as  to  forward  me,  and  cheerfully  and  fully  concur  in 
the  commendations  of  its  value,  as  a comprehensive  and  enlightened  survey  of 
the  ancient  and  modern  world,  which  many  of  the  most  competent  judges  have, 
as  I perceive,  already  bestowed  upon  it.  It  appears  to  me  to  be  admirably  adapted 
to  the  purposes  of  our  public  schools  ; and  I unhesitatingly  approve  of  its  intro- 
duction into  these  seminaries  of  elementary  instruction. 

Very  respectfully,  your  obedient  servant, 

SAMUEL  S.  RANDALL, 
Deputy  Superintendent  of  Common  Schools. 

As  this  work  is  prepared  with  reference  to  general  reading,  as  well  as  for 
Schools,  an  edition  has  been  prepared  without  questions,  making  it  a very  valua- 
ble volume  for  District  School  and  other  Libraries. 


PUBLISHED  BY  LEA  & BLANCHARD; 


1 


WORKS  FOR 

SCHOOLS,  COLLEGES,  &C. 


A NEW  EDITION  OF 

ARNOTT’S  ELEMENTS  OF  PHYSICS,  OR  NATURAL  PHI- 
LOSOPHY, GENER  VL  AND  MEDICAL.  Written  for  universal 
use,  in  plain,  or  non-technical  language.  Complete  in  1 vol.  Revised 
and  corrected  from  the  last  English  edition,  with  additions,  by  Isaac 
Hays,  M.  D.  A work  used  extensively  in  various  seminaries. 

HERSCHEL’S  ASTRONOMY,  a new  edition,  with  a preface,  and  a 
Series  of  Questions  for  the  examination  of  Students,  with  Engravings, 
by  S.  C.  Walker,  in  1 vol.,  12mo. 

BREWSTER’S  OPTICS,  a new  edition,  with  an  appendix,  and  numerous 
cuts,  by  Professor  Bache,  in  1 vol.,  12mo. 

BUTLER’S  ATLAS  OF  ANCIENT  GEOGRAPHY,  consisting  03 
21  coloured  maps,  with  a complete  accentuated  index. 

BUTLER’S  GEOGRAPIIIA  CLASSICA,  or  the  Application  of 
Ancient  Geography  to  the  Classics ; 4th  American  edition,  with  Ques- 
tions, 1 vol. 


Bolmar'1 s French  Series. 

New  editions  of  the  following  works,  by  A.  Bolmar,  forming  in  connec- 
tion with  “ Bohr.ar’s  Levizac,”  a complete  series  for  the  acquisition  of  the 
French  language. 

A SELECTION  OF  ONE  HUNDRED  PERRIN’S  FABLES, 

accompanied  by  a Key,  containing  the  text,  a literal  and  free  transla- 
tion, arranged  in  such  a manner  as  to  point  out  the  difference  between 
the  French  and  English  idiom,  &c.,  in  1 vol.,  12mo. 

A COLLECTION  OF  COLLOQUIAL  PHRASES,  on  every  topic 
necessary  to  maintain  conversation,  arranged  under  different  heads  with 
numerous  remarks  on  the  peculiar  pronunciation  and  uses  of  various 
words  ; the  whole  so  disposed  as  considerably  to  facilitate  the  acquisi- 
tion of  a correct  pronunciation  of  the  French,  1 vol.,  18mo. 

LES  AVENTURES  DE  TELEMAQUE  PAR  FENELON,  in  1 

vol.,  12mo.,  accompanied  by  a Key  to  the  first  eight  books,  in  1 vol., 
12mo.,  containing  like  the  Fables,  the  text,  a literal  and  free  translation, 
intended  as  a sequel  to  the  Fables.  Either  volume  sold  separately. 

ALL  THE  FRENCH  VERBS,  both  regular  and  irregular,  in  a small  1 
volume. 


SOLD  BY  ALL  BOOKSELLERS. 


PUBLISHED  BY  LEA  AND  BLANCHARD. 


CHEMISTRY  FOR  STUDENTS: 

ELEMENTARY  CHEMISTRY, 

THEORETICAL  AND  PRACTICAL; 

BY  GEORGE  FOWNES,  PH.D. 

CHEMICAL  LECTURER  TO  THE  MIDDLESEX  HOSPITAL  MEDICAL  SCHOOL,  ETC.  ETC. 

EDITED,  ‘WITH  ADDITIONS, 

BY  ROBERT  BRIDGES,  M.  D., 

PROFESSOR  OF  GENERAL  AND  PHARMACEUTICAL  CHEMISTRY  IN  THE  PHILA- 
DELPHIA COLLEGE  OF  PHARMACY,  ETC. 

In  on©  large  12mo«  volume,  with,  nearly  two  hundred  wood-cuts* 

The  character  of  this  work  is  such  as  to  recommend  it  to  all  colleges  and  academies  in  want 
of  a text-book.  It  is  fully  brought  up  to  the  day,  containing  all  the  late  views  and  discoveries 
that  have  so  entirely  changed  the  face  of  the  science,  and  it  is  completely  illustrated  with  very 
numerous  wood  engravings,  explanatory  of  all  the  different  processes  and  forms  of  apparatus. 
Though  strictly  scientific,  it  is  written  with  great  clearness  and  simplicity  of  style,  rendering  it 
easy  to  be  comprehended  by  those  who  arc  commencing  the  study. 

It  may  be  had  well  bound  in  leather,  or  neatly  done  up  in  strong  cloth.  Its  low  price  places 
it  within  the  reach  of  all. 

Extract  of  a letter  from  Professor  Millington,  of  William  and  Mary  College,  Va. 

" 1 have  perused  the  book  with  much  pleasure,  and  find  it  a most  admirable  work ; and,  to  my 
mind,  such  a one  as  is  just  now  much  needed  in  schools  and  colleges.  * * * All  the  books  I 
have  met  with  on  chemistry  are  either  too  puerile  or  too  erudite,  and  I confess  Dr.  Fownes  Dook 
seems  to  be  the  happiest  medium  I have  seen,  and  admirably  suited  to  fill  up  the  hiatus.” 

“ He  has  succeeded  in  comprising  the  matter  of  his  work  in  460  duodecimo  pages,  which,  as- 
suredly, is  a recommendation  of  the  volume  as  a text-book  for  students.  In  this  respect  it  has 
advantages  over  any  treatise  which  has  yet  been  offered  to  American  students.  The  difficulty 
in  a text- book  of  chemistry  is  to  treat  the  subject  with  sufficient  fulness,  without  going  too  much 
into  detail.  For  students  comparatively  ignorant  of  chemical  science,  the  larger  systems  are 
unprofitable  companions  in  their  attendance  upon  lectures.  They  need  a work  of  a more  ele- 
mentary character,  by  which  they  may  be  inducted  into  the  first  principles  of  the  science,  and 
prepared  for  mastering  its  more  abstruse  subjects.  Such  a treatise  is  the  one  which  we  have 
now  the  pleasure  of  introducing  to  our  readers;  no  manual  of  chemistry  with  which  we  have 
met  comes  so  near  meeting  the  wants  of  the  beginner.  All  the  prominent  truths  of  the  science, 
up  to  the  present  time,  will  be  found  given  in  it  with  the  utmost  practicable  brevity.  The  style 
is  admirable  for  its  conciseness  and  clearness.  Many  wood  cuts  are  supplied,  by  which  pro- 
cesses are  made  intelligible.  The  author  expresses  regret  that  he  could  not  enter  more  largely 
into  organic  chemistry,  but  his  details  will  be  found  to  embrace  the  most  important  facts  in  that 
interesting  branch  of  the  science.  We  shall  recommend  his  manual  to  our  class  next  winter.” — 
The  Western  Journal  of  Medicine  and  Surgery . 


Though  this  work  has  been  so  recently  published,  it  has  already  been 
adopted  as  a text-book  by  a large  number  of  the  higher  schools  and 
colleges  throughout  the  country,  as  well  as  by  Professor  Silliman,  and 
many  of  the  Medical  Institutions.  As  a work  for  the  upper  classes  in 
academies  and  the  junior  students  of  colleges,  there  has  been  but  one 
opinion  expressed  concerning  it,  and  it  may  now  be  considered  as  the 
Text-book  for  the  Chemical  Student. 


PUBLISHED  BY  LEA  AND  BLANCHARD, 

Now  ready , in  One  Volume  8 vo.  with  Illustrations. 

THE  HORSE, 

BY  WILLIAM  YOUATT. 

A NEW  EDITION,  WITH  NUMEROUS  ILLUSTRATIONS; 
CONTAINING-  A FULL  ACCOUNT  OF  THE 

DISEASES  OF  THE  HORSE, 

WITH  THEIR  MODE  OF  TREATMENT; 

HIS  ANATOMY, 

AND  THE  USUAL  OPERATIONS  PERFORMED  ON  HIM; 

HIS  BREEDING,  BREAKING,  AND  MANAGEMENT: 

AND  HINTS  ON  HIS  SOUNDNESS,  AND  THE 
PURCHASE  AND  SALE. 

TOGETHER  WITH  A 

GENERAL  HISTORY  OE  THE  HORSE; 

A DISSERTATION  ON 

THE  AMERICAN  TROTTING  HORSE, 

HOW  TRAINED  AND  JOCKEYED, 

AN  ACCOUNT  OF  HIS  REMARKABLE  PERFORMANCES; 

AND 

AN  ESSAY  ON  THE  ASS  AND  THE  MULE, 

BY  J.  S.  SKINNER, 

Assistant  Post  Mastet  General,  and  Editor  of  the  Turf  Register. 


PHILADELPHIA: 

LEA  AND  BLANCHARD. 

1 844. 

REPUBLISHED  FROM  THE  NEW  EDITION  JUST  ISSUED  IN  LONDON, 
BY  THE  SOCIETY  FOR  DIFFUSING  USEFUL  KNOWLEDGE. 

PHILADELPHIA. 


WORKS  FOR  SPORTSMEN. 

PUBLISHED  BY  LEA  AND  BLANCHARD. 

SKINNER’S  DOG  AND  SPORTSMAN. 

THE  DOG  AND  THE  SPORTSMAN. 

MBRACING  THE  USES,  BREEDING,  TRAINING,  DISEASES,  ETC.,  OF  DOGS,  AND  AN  AC- 
COUNT OF  THE  DIFFERENT  KINDS  OF  GAME,  WITH  THEIR  HABITS. 

ALSO,  HINTS  TO  SHOOTERS, 

WITH  VARIOUS  USEFUL  RECIPES,  &c.,  &c. 

By  J.  S.  SKINNER. 

With  Plates.  In  one  very  neat  12 mo.  volume,  extra  cloth. 

“This  is  an  excellent  book.  It  shows  how  serviceable  the  dog  maybe  made, 
nd  how  to  make  him  serviceable.  The  excellent  advice  upon  the  treatment  of 
le  half-reasoning  animal,  (some  dogs  do  reason,)  should  be  read  by  every  one 
'ho  aspires  to  own  a dog,  that  is  serviceable  in  the  field.” — U.  S.  Gazette. 

YOUATT  ON  THE  DOG. 

THE  DOG. 

BY  WILLIAM  YOUATT. 

ONTAINING  THE  HISTORY  OF  THE  DOG,  HIS  VARIETIES,  QUALITIES, 
ANATOMY,  DISEASES,  TREATMENT,  BREEDING,  &c.,  &c. 

In  one  beautiful  volume,  with  all  the  fine  illustrations  beautifully  executed. 

Preparing. 

CLATER’S  FARRIER. 

EVERY  MAN  HIS  OWN  FARRIER ; 

iONTAINING  THE  CAUSES,  SYMPTOMS,  AND  MOST  APPROVED 
METHODS  OF  CURE  OF  THE  DISEASES  OF  HORSES. 

BY  FRANCIS  CLATER, 

Author  of  “Every  Man  his  own  Cattle  Doctor.” 

And  his  Son  JOHN  CLATER. 

FIRST  AMERICAN  FROM  THE  TWENTY-EIGHTH  LONDON  EDITION,  WITH  NOTES  AND 

ADDITIONS, 

BY  J.  S.  SKINNER. 

In  one  12mo.  volume,  cloth. 

. c‘Lea  & Blanchard  have  just  published  Clater’s  capital  treatise  on  the  Diseases  of 
torses,  containing  ‘ the  causes,  symptoms,  and  most  approved  methods  of  cure,’  with 
. iluable  notes  and  additions  by  J.  S.  Skinner,  Esq.  This  is  the  first  American  from 
i le  twenty-eighth  English  edition  of  this  standard  work,  which  should  find  its  way 
ito  the  hands  of  every  lover  of  the  Horse.” — N.  Y.  Spirit  of  the  Times. 

CLATER’S  CATTLE  DOCTOR. 

EVERY  MAN  HIS  OWN  CATTLE  DOCTOR. 

/ONTAINING  THE  CAUSES,  SYMPTOMS  AND  TREATMENT  OF  ALL  DISEASES  INCIDENT  TO 

Oxen,  Sheep  and  Swine;  and  a Sketch  of  the  Anatomy  and  Physi- 
ology of  Neat  Cattle.  By  FRANCIS  CLATER. 

Idited,  Revised,  and  almost  Rewritten,  by  William  Youatt.  With  Numerous  Addi- 
tions, embracing  an  Essay  on  the  Use  of  Oxen,  and  the  Improvement  in  the 
Breed  of  Sheep,  by  J.  S.  Skinner,  Asst.  P.  M.  General. 

In  one  duodecimo  volume,  cloth,  with  numerous  illustrations. 


WORKS  FOR  SPORTSMEN. 

PUBLISHED  BY  LEA.  & BLANCHARD. 

HAWKER  ON  SHOOTING. 

Preparing \ 

INSTRUCTIONS  TO  YOUNG  SPORTSMEN  IN  ALL 
THAT  RELATES  TO  GUNS  AND  SHOOTING. 

By  Lieut.  Col.  P.  HAWKER. 

From  the  Enlarged  and  Improved  Ninth  London  Edition. 

EDITED  WITH  MANS’  ALTERATIONS  AND  ADDITIONS, 

By  W.  T.  PORTER,  Esq.,  Editor  of  the  N.  Y.  Spirit  of  the  Times. 

In  one  large  octavo  volume,  with  numerous  Illustrations. 

This  has  long  been  considered  as  the  standard  work  on  shooting,  and  of  t 
highest  authority  on  all  that  appertains  to  guns  and  their  use.  An  Americ 
edition  has  been  much  wanted,  that  sportsmen  in  this  country  might  have  su 
a work  at  a reasonable  price.  The  editor,  who  is  well  known  to  the  sporti 
world  on  this  side  of  the  water,  has  made  very  extensive  alterations,  so  as 
adapt  it  to  our  game  and  sporting  customs.  Many  new  and  beautiful  woodci 
have  been  introduced,  in  place  of  comparatively  unimportant  ones  omitte 
and  the  whole  is  confidently  presented  to  the  sportsmen  of  the  United  States 
a work  in  every  respect  calculated  to  meet  their  wants. 

STABLE  TALK  AND  TABLE  TALK. 

STABLE  TALK  AND  TABLE  TALK, 

OR  SPECTACLES  FOR  YOUNG  SPORTSMEN. 

BY  HARRY  HIEOVER. 

In  one  very  neat  duodecimo  volume,  extra  cloth. 

These  lively  sketches  answer  to  their  title  very  well.  Wherever  Nimrod 
welcome,  there  should  be  cordial  greeting  for  Harry  Hieover.  His  book  it 
very  clever  one,  and  contains  many  instructive  hints,  as  well  as  much  lig 
hearted  reading. — Examiner. 

SPORTSMAN’S  LIBRARY. 

THE  SPORTSMAN’S  LIBRARY, 

OR 

HINTS  ON  HUNTERS,  HUNTING,  HOUNDS,  SHOOTING,  GAMI 

DOGS,  GUNS,  FISHING,  COURSING,  &c.  &c. 

In  one  well  printed  volume,  duodecimo,  extra  cloth. 

“ It  has  been  my  object  to  render  this  work  one  of  instruction  and  of  referc, 
as  to  every  subject  connected  with  our  national  sports.  In  the  belief  that  the  ti 
has  been  completed  in  accordance  with  the  design,  I submit  the  work  in  all  1 
mility,  to  the  favourable  consideration  of  those  whom  I am  proud  to  call  my  1 
low-sportsmen.” — Preface. 


0®Q>E>a®*>© 


5 


TWEUTY'PIVE  CENTS  PEH  VOLUME. 


LEA  & BLANCHARD 

HAVE  COMMENCED  THE  RE-ISSUE,  IN  A PERIODICAL  FORM,  OF 

smu  srcD'wisas  ibcdmiasj^iis 


FENIMORE  COOPER 

EMBRACING 

WING-AND- WING, 


THE  SPY, 

THE  PILOT, 

THE  WATER-WITCH, 
LIONEL  LINCOLN, 
HEIDENMAUER, 

THE  PATHFINDER, 
PRECAUTION, 

THE  WISH-TON-WISH, 
HOMEWARD  BOUND, 
MERCEDES  OF  CASTILE, 


THE  PIONEERS, 

THE  RED  ROVER, 

THE  TWO  ADMIRALS, 

THE  PRAIRIE, 

THE  HEADSMAN, 

THE  DEERSLAYER, 

THE  BRAVO, 

THE  LAST  of  the  MOHICANS, 
HOME  AS  FOUND, 

THE  MONIKINS, 

AND  THE  TRAVELLING  BACHELOR, 

In  all  twenty-two  different  Works,  or  forty-four  volumes. 


This  edition  will  be  well  printed,  on  good  paper  and  with  legible 
type,  and  in  a form  suitable  for  convenient  reading,  and  done  up  in 
a coloured  wrapper.  As  they  will  all  correspond  in  size,  the  set 
can  be  bound  to  match,  and  will  form  a beautiful  series  after  it  is 
complete. 

A work  in  two  volumes,  will  be  issued  every  week  until  the  series 
is  complete. 

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postage  of  l|  cent  per  sheet  for  100  miles  or  less,  and  at  2£  cents 
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Other  works,  in  a cheap  form  for  extensive  circulation,  such  as 
Boz,  Fielding,  Smollett,  &c.  will  follow. 

Philadelphia , December,  1842. 


CHEAP  EDITION  OF  SMOLLETT.  — $1  50. 


WITH  A MEMOIR  OF  HIS  LIFE  AND  WRITINGS,  BY  SIR  WALTER  SCOTT, 

CONTAINING 

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and  closely  printed  pages.  Second  Edition,  nearly  300  wood- 
cuts. 


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lea  & Blanchard’s  scientific  publications. 


ROYLE’S  MATERIA  MEDICA,  edited  by  Dr.  Carson,  with 
beautiful  wood-cuts,  nearly  ready,  1 vol.  8vo. 

ROGET’S  ANIMAL  AND  VEGETABLE  PHYSIOLOGY,  with 
over  400  cuts,  2 vols.  8vo,  872  pages. 

ROGET’S  OUTLINES  OF  PHYSIOLOGY,  1 vol.  8vo,  516 
pages. 

RIGBY’S  SYSTEM  OF  MIDWIFERY,  1 vol.  8vo,  492  pages. 

RICORD  ON  VENEREAL,  new  edition,  1 vol.  8vo,  256  pages. 

RAMSBOTHAM  ON  PARTURITION,  with  many  plates,  1 vol. 
imperial  8vo,  a new  and  improved  edition,  520  pages. 

ROBERTSON  ON  THE  TEETH,  1 vol.  8vo,  230  pages. 

SIMON’S  CPIEMISTRY  OF  MAN,  translated  by  Day,  complete 
in  1 vol.  8vo,  730  pages,  plates. 

TRIMMER’S  GEOLOGY  AND  MINERALOGY,  1 vol.  Svo, 
528  pages,  many  cuts. 

TODD  & BOWMAN’S  PHYSIOLOGY,  publishing  in  the  Medi- 
cal News  and  Library,  with  many  cuts. 

THOMSON  ON  THE  SICK  ROOM,  l_vol.  12mo,  360  pages, 
with  cuts. 

VOGEL’S  PATHOLOGICAL  ANATOMY,  with  plates,  pre- 
paring. 

WALSHE  ON  THE  DISEASES  OF  THE  LUNGS,  1 vol.  12mo, 
310  pages. 

WATSON’S  PRINCIPLES  AND  PRACTICE  OF  PHYSIC,  se- 
cond edition  by  Condie,  1 vol.  8vo,  1060  large  pages. 

WILSON’S  HUMAN  ANATOMY,  with  cuts,  1 vol.  8vo,  a new 
and  improved  edition,  608  pages. 

WILSON’S  DISSECTOR,  OR  PRACTICAL  AND  SURGICAL 
ANATOMY,  by  Goddard,  with  cuts,  1 vol.  12mo,  444  pages. 

WILSON  ON  THE  SKIN,  1 vol.  Svo,  370  pages. 

YOUATT  ON  THE  HORSE,  by  Skinner,  with  cuts,  448  pages, 
1 vol.  Svo. 

YOUATT  AND  CLATER’S  CATTLE  DOCTOR,  1 vol.  12mo, 
with  cuts,  282  pages. 

WILLIAMS’  PATHOLOGY,  OR  PRINCIPLES  OF  MEDI- 
CINE, 1 vol.  Svo,  384  pages. 

WILLIAMS  ON  THE  RESPIRATORY  ORGANS,  by  Clymer, 
1 vol.  Svo,  500  pages. 


Will  be  Ready  in  September  IS46, 

A FOURTEENTH  AND  SUPPLEMENTARY  VOLUME 
OF  THE 

ENCYCLOPAEDIA  AMERICANA, 

By  HENRY  VETHAKE,  Esq.,  LL.D., 

Professor  of  Mathematics  in  the  University  of  Pennsylvania,  etc. 


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